Provider Demographics
NPI:1841587037
Name:PATEL, PRIYA (MSPA-C)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:MSPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12564 CENTRAL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3573
Mailing Address - Country:US
Mailing Address - Phone:909-591-1444
Mailing Address - Fax:
Practice Address - Street 1:12564 CENTRAL AVE STE B
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3573
Practice Address - Country:US
Practice Address - Phone:909-591-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 17808363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant