Provider Demographics
NPI:1629537352
Name:PLATINUM DIGESTIVE HEALTH
Entity Type:Organization
Organization Name:PLATINUM DIGESTIVE HEALTH
Other - Org Name:PLATINUM DIGESTIVE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:BHAVESHKUMAR
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-556-5988
Mailing Address - Street 1:9481 PITTSBURGH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-9021
Mailing Address - Country:US
Mailing Address - Phone:909-655-0300
Mailing Address - Fax:909-655-1161
Practice Address - Street 1:9481 PITTSBURGH AVE STE 200
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-9021
Practice Address - Country:US
Practice Address - Phone:909-655-0300
Practice Address - Fax:909-655-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2023-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1629537352Medicaid