Provider Demographics
NPI:1659839801
Name:PATEL, PRATIK U (PSY D)
Entity Type:Individual
Prefix:DR
First Name:PRATIK
Middle Name:U
Last Name:PATEL
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23986 ALISO CREEK RD
Mailing Address - Street 2:# 210
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3908
Mailing Address - Country:US
Mailing Address - Phone:323-489-5880
Mailing Address - Fax:
Practice Address - Street 1:23986 ALISO CREEK RD
Practice Address - Street 2:# 210
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3908
Practice Address - Country:US
Practice Address - Phone:323-489-5880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical