Provider Demographics
NPI:1568664985
Name:RENEE PATEL MD, INCORPORATED
Entity Type:Organization
Organization Name:RENEE PATEL MD, INCORPORATED
Other - Org Name:RENEE PATEL MD, INCORPORATED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENUKA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-622-2470
Mailing Address - Street 1:8357 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3928
Mailing Address - Country:US
Mailing Address - Phone:562-622-2470
Mailing Address - Fax:562-622-2474
Practice Address - Street 1:8357 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3928
Practice Address - Country:US
Practice Address - Phone:562-622-2470
Practice Address - Fax:562-622-2474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43090207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A430900Medicaid
CA110017338OtherMEDICARE RR
CAA43090Medicare PIN
CAW20938Medicare PIN