Provider Demographics
NPI:1568656593
Name:PATEL, AMI J (PA-C)
Entity Type:Individual
Prefix:
First Name:AMI
Middle Name:J
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15899 LOS GATOS ALMADEN RD
Mailing Address - Street 2:#4
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032
Mailing Address - Country:US
Mailing Address - Phone:408-358-8801
Mailing Address - Fax:
Practice Address - Street 1:15899 LOS GATOS ALMADEN RD
Practice Address - Street 2:#4
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032
Practice Address - Country:US
Practice Address - Phone:408-358-8801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-03
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19318363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant