Provider Demographics
NPI:1700817632
Name:PATEL, AMIKSHA S (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIKSHA
Middle Name:S
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMIKSHA
Other - Middle Name:P
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:436 GREEN ORCHARD PL
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-7590
Mailing Address - Country:US
Mailing Address - Phone:951-750-2260
Mailing Address - Fax:951-689-6462
Practice Address - Street 1:3975 JACKSON ST
Practice Address - Street 2:SUITE # 203
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3901
Practice Address - Country:US
Practice Address - Phone:951-689-6889
Practice Address - Fax:951-689-6462
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78581207QG0300X
CAA 78581207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB9534082OtherDRIVERS LIC #
CAA 78581OtherSTATE LICENSE
CAA 78581OtherSTATE LICENSE
CAA 78581OtherSTATE LICENSE