Provider Demographics
NPI:1376728253
Name:PATEL, NIMA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MISS
First Name:NIMA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 LONDON CT
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-3905
Mailing Address - Country:US
Mailing Address - Phone:650-888-9820
Mailing Address - Fax:650-876-0861
Practice Address - Street 1:1828 EL CAMINO REAL
Practice Address - Street 2:STE 611
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3103
Practice Address - Country:US
Practice Address - Phone:650-696-2431
Practice Address - Fax:650-696-3659
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19204363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant