Provider Demographics
NPI:1508648106
Name:PATEL, JENNIE (PA)
Entity type:Individual
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First Name:JENNIE
Middle Name:
Last Name:PATEL
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Gender:
Credentials:PA
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Mailing Address - Street 1:341 MAGNOLIA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3331
Mailing Address - Country:US
Mailing Address - Phone:951-735-6060
Mailing Address - Fax:951-735-4510
Practice Address - Street 1:341 MAGNOLIA AVE STE 101
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3331
Practice Address - Country:US
Practice Address - Phone:951-735-6060
Practice Address - Fax:951-735-4510
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2025-04-24
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant