Provider Demographics
NPI:1932324647
Name:PATEL, VIMAL (RPH, CCN, CAD, DIHOM)
Entity Type:Individual
Prefix:
First Name:VIMAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPH, CCN, CAD, DIHOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15105 N 93RD WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2827
Mailing Address - Country:US
Mailing Address - Phone:480-767-7751
Mailing Address - Fax:
Practice Address - Street 1:8952 E DESERT COVE AVE #103
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260
Practice Address - Country:US
Practice Address - Phone:480-767-7751
Practice Address - Fax:480-767-7754
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
605101YP2500X, 101Y00000X, 101YA0400X
3130132700000X, 133NN1002X, 174400000X
175L00000X
AZ9492183500000X, 1835N1003X
AZS009492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No132700000XDietary & Nutritional Service ProvidersDietary Manager
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No174400000XOther Service ProvidersSpecialist
No175L00000XOther Service ProvidersHomeopath
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS009492OtherSTATE BOARD OF PHARMACY