Provider Demographics
NPI:1669403168
Name:PATEL, URMILA M (MD)
Entity type:Individual
Prefix:
First Name:URMILA
Middle Name:M
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 1:625 FAIR OAKS AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5801
Mailing Address - Country:US
Mailing Address - Phone:626-346-2455
Mailing Address - Fax:626-639-3005
Practice Address - Street 1:1151 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-6155
Practice Address - Country:US
Practice Address - Phone:909-467-0797
Practice Address - Fax:877-778-8097
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50437208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01365656OtherRAILROAD MEDICARE- DU4034
CAP01272655/DU4032OtherRAILROAD MEDICARE
CA00A504370OtherMEDI CAL
CAWA50437DMedicare PIN
CAFC314Y-EFF 3/6/12Medicare PIN
CAWA50437EMedicare PIN
CAP01365656OtherRAILROAD MEDICARE- DU4034
CAFC314XMedicare PIN
CA00A504370Medicare PIN
CAP01272655/DU4032OtherRAILROAD MEDICARE
CAWA50437KMedicare PIN
CAWA50437FMedicare PIN
CAWA50437GMedicare PIN
CAWA50437JMedicare PIN