Provider Demographics
NPI:1710208483
Name:PATEL, PUNAM (MD)
Entity Type:Individual
Prefix:DR
First Name:PUNAM
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PUNAM
Other - Middle Name:VINOD
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1223 FEDERAL AVE
Mailing Address - Street 2:APARTMENT 110
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3915
Mailing Address - Country:US
Mailing Address - Phone:760-458-9410
Mailing Address - Fax:
Practice Address - Street 1:10945 LE CONTE AVE
Practice Address - Street 2:SUITE 2339
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1687
Practice Address - Country:US
Practice Address - Phone:310-825-6301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA115029207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine