Provider Demographics
NPI:1437812260
Name:RADIA, DIPALI PATEL (PA)
Entity Type:Individual
Prefix:
First Name:DIPALI
Middle Name:PATEL
Last Name:RADIA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 N MILLIKEN AVE # 1173
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5083
Mailing Address - Country:US
Mailing Address - Phone:714-455-9831
Mailing Address - Fax:
Practice Address - Street 1:10938 COCHRAN AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3010
Practice Address - Country:US
Practice Address - Phone:714-553-9160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant