Provider Demographics
NPI:1922669548
Name:PATEL, VIRAJ BAKUL (DO)
Entity Type:Individual
Prefix:
First Name:VIRAJ
Middle Name:BAKUL
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 W ROSECRANS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-6686
Mailing Address - Country:US
Mailing Address - Phone:310-643-8500
Mailing Address - Fax:310-536-0495
Practice Address - Street 1:5400 W ROSECRANS AVE STE 100
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-6686
Practice Address - Country:US
Practice Address - Phone:310-643-8500
Practice Address - Fax:310-536-0495
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A21726207RS0010X
PAOT019567207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine