Provider Demographics
NPI:1376593657
Name:PATEL, GNYANDEV (MD)
Entity Type:Individual
Prefix:DR
First Name:GNYANDEV
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90707-0189
Mailing Address - Country:US
Mailing Address - Phone:562-232-2378
Mailing Address - Fax:562-232-2379
Practice Address - Street 1:3300 E SOUTH ST
Practice Address - Street 2:SUITE # 206
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90805-4549
Practice Address - Country:US
Practice Address - Phone:562-232-2378
Practice Address - Fax:562-232-2379
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA618690174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA200059993OtherE.I.N NO.
CA00A618690OtherB/C PROVIDER NO.
CA00A618690OtherB/S PROVIDER NO.
CAA618690OtherSTATE LICENSE NO.
CAA618690OtherSTATE LICENSE NO.
CAWA61869EMedicare ID - Type UnspecifiedMCARE PROVIDER NO.