Provider Demographics
NPI:1134448152
Name:PATEL, RIMA GUNVANTRAI (PA-C)
Entity type:Individual
Prefix:MS
First Name:RIMA
Middle Name:GUNVANTRAI
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17940 N MILITARY TRAIL, UNIT 300
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1818 E SKY HARBOR CIR N STE 150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-3410
Practice Address - Country:US
Practice Address - Phone:602-256-5950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00236700363A00000X, 363AM0700X, 363AS0400X
MN11076363A00000X
MELT20089363A00000X
FLPA9111002363A00000X
MEPA405363A00000X
NHEL04722363A00000X
MAPA-TF-0179363A00000X
CA54272363A00000X
AZ4782363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN970005937Medicare PIN