Provider Demographics
NPI:1578729851
Name:PATEL, HEENA RAJENDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:HEENA
Middle Name:RAJENDRA
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4108 DEL REY AVE
Mailing Address - Street 2:UNIT 304
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-4804
Mailing Address - Country:US
Mailing Address - Phone:773-816-2242
Mailing Address - Fax:
Practice Address - Street 1:9985 SIERRA AVE BLDG 4
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6720
Practice Address - Country:US
Practice Address - Phone:888-750-0036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA132444207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology