Provider Demographics
NPI:1790812972
Name:NILESH PATEL MD
Entity Type:Organization
Organization Name:NILESH PATEL MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:NILESH
Authorized Official - Middle Name:N
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-914-1514
Mailing Address - Street 1:215 SOUTH CITRUS STREET
Mailing Address - Street 2:# 393
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-2113
Mailing Address - Country:US
Mailing Address - Phone:626-914-1534
Mailing Address - Fax:626-914-1505
Practice Address - Street 1:130 W ROUTE 66
Practice Address - Street 2:#302
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6249
Practice Address - Country:US
Practice Address - Phone:626-914-1534
Practice Address - Fax:626-914-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66234207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A662340Medicaid
CAA066234OtherCALIFORNIA LICENSE
CAA066234OtherCALIFORNIA LICENSE
A66234Medicare ID - Type UnspecifiedMEDICARE NUMBER