Provider Demographics
NPI:1750492013
Name:PATEL, DHARINI MAHENDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:DHARINI
Middle Name:MAHENDRA
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 1:5451 LA PALMA AVE
Mailing Address - Street 2:STE 15
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1728
Mailing Address - Country:US
Mailing Address - Phone:714-809-2221
Mailing Address - Fax:
Practice Address - Street 1:5451 LA PALMA AVE
Practice Address - Street 2:STE 15
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1728
Practice Address - Country:US
Practice Address - Phone:714-809-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72427207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A724270OtherBLUE SHIELD ID #
CA00A724270Medicaid
CA00A724270385OtherCALOPTIMA ID #
CA00A724270385OtherCALOPTIMA ID #
CA00A724270Medicaid