Provider Demographics
NPI:1760099477
Name:PATEL, DIPALIBAHEN C
Entity Type:Individual
Prefix:
First Name:DIPALIBAHEN
Middle Name:C
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 CAPEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-1111
Mailing Address - Country:US
Mailing Address - Phone:408-341-5122
Mailing Address - Fax:
Practice Address - Street 1:2680 UNION AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-1348
Practice Address - Country:US
Practice Address - Phone:408-371-5426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH83255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist