Provider Demographics
NPI:1932511904
Name:PATEL, NIKITA MOHAN (MD)
Entity Type:Individual
Prefix:
First Name:NIKITA
Middle Name:MOHAN
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 FAIR OAKS AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3929
Mailing Address - Country:US
Mailing Address - Phone:805-547-2224
Mailing Address - Fax:805-474-5248
Practice Address - Street 1:850 FAIR OAKS AVE STE 220
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3929
Practice Address - Country:US
Practice Address - Phone:805-547-2224
Practice Address - Fax:805-474-5276
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO60871207R00000X, 207RG0300X
NMMD2019-0933207R00000X
CAA143360207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine