Provider Demographics
NPI:1326706292
Name:PATEL, DEEPA RAMESH
Entity Type:Individual
Prefix:
First Name:DEEPA
Middle Name:RAMESH
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 BELOIT AVE APT 220
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6378
Mailing Address - Country:US
Mailing Address - Phone:501-944-9978
Mailing Address - Fax:
Practice Address - Street 1:1929 BELOIT AVE APT 220
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6378
Practice Address - Country:US
Practice Address - Phone:501-944-9978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1-18-32945103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst