Provider Demographics
NPI:1700855145
Name:PATEL, AVAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:AVAN
Middle Name:M
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 W LOOP DR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2035
Mailing Address - Country:US
Mailing Address - Phone:805-484-0055
Mailing Address - Fax:805-484-4439
Practice Address - Street 1:58 W LOOP DR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2035
Practice Address - Country:US
Practice Address - Phone:805-484-0055
Practice Address - Fax:805-484-4439
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101189207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265456768Medicaid