Provider Demographics
NPI:1720136948
Name:PATEL, PINTU (PA-C)
Entity Type:Individual
Prefix:
First Name:PINTU
Middle Name:
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 1:200 OCEANGATE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4302
Mailing Address - Country:US
Mailing Address - Phone:562-499-6191
Mailing Address - Fax:909-882-8819
Practice Address - Street 1:190 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3658
Practice Address - Country:US
Practice Address - Phone:909-882-4788
Practice Address - Fax:909-882-8819
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17016207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEFF.9/6/13-SORIVERSIMedicaid
CAEFF:1/1/12-VICTORVILMedicaid
CAPA17016OtherMEDI-CAL
CAEFF 9/6/13-N.RIVERSIMedicaid
CAEFF.9/6/13-MORENOVALMedicaid
CAP01288550/ DU4034OtherRAILROAD MEDICARE- SAN BERNARDINO
CAPA17016Medicaid
CAEFF: 2/20/2013Medicaid
CAEFF: 7/19/13 RIALTOMedicaid
CAEFF 7/19/13 FONTANAMedicaid
CAP01520352 - DU5182OtherRR MEDICARE - COLTON & VICTORVILLE
CAEFF: 7/13/15-COLTONMedicaid
CAEFF:1/1/12-VICTORVILMedicaid
CAEFF: 7/19/13 RIALTOMedicaid
CAEO793WMedicare PIN
CAEO793YMedicare PIN
CAEFF.9/6/13-SORIVERSIMedicaid