Provider Demographics
NPI:1609811132
Name:PATWA, VINOD KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:VINOD
Middle Name:KUMAR
Last Name:PATWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-837-8767
Mailing Address - Fax:760-837-8806
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-837-8767
Practice Address - Fax:760-837-8806
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1079772084P0800X
OH35043424P2084P0800X
CAC517572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0414591Medicaid
OHC01688Medicare UPIN
OH0414591Medicaid
OHH183921Medicare PIN