Provider Demographics
NPI:1023154622
Name:PATEL, GITANJALI J (DPM)
Entity type:Individual
Prefix:
First Name:GITANJALI
Middle Name:J
Last Name:PATEL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:GITA
Other - Middle Name:H
Other - Last Name:JHALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:2340 ALMOND AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2026
Mailing Address - Country:US
Mailing Address - Phone:925-827-4056
Mailing Address - Fax:925-407-8352
Practice Address - Street 1:2340 ALMOND AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2026
Practice Address - Country:US
Practice Address - Phone:925-827-4056
Practice Address - Fax:925-407-8352
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4559213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E45591OtherPTAN
CAZZZ25716ZMedicare PIN
CA000E45591OtherPTAN
CA4744190002Medicare NSC