Provider Demographics
NPI:1710512124
Name:PATEL, MAMATA S (FNP)
Entity Type:Individual
Prefix:
First Name:MAMATA
Middle Name:S
Last Name:PATEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MAMATA
Other - Middle Name:
Other - Last Name:BHANDERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5727 W LAS POSITAS BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-4263
Mailing Address - Country:US
Mailing Address - Phone:925-416-6767
Mailing Address - Fax:
Practice Address - Street 1:5727 W LAS POSITAS BLVD STE 110
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-4263
Practice Address - Country:US
Practice Address - Phone:925-416-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013048363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner