Provider Demographics
NPI:1962636522
Name:PATEL, AJAY HARIVADAN (MD)
Entity Type:Individual
Prefix:DR
First Name:AJAY
Middle Name:HARIVADAN
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5828 CANTER COVE CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2659
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10441 LAKEWOOD BLVD STE E
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-2744
Practice Address - Country:US
Practice Address - Phone:562-869-3585
Practice Address - Fax:562-869-3590
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1207932081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine