Provider Demographics
NPI:1720641020
Name:PATEL, MAITRI KAMLESHKUMAR
Entity Type:Individual
Prefix:
First Name:MAITRI
Middle Name:KAMLESHKUMAR
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5399 W CENTINELA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-2003
Mailing Address - Country:US
Mailing Address - Phone:310-670-3335
Mailing Address - Fax:310-670-1153
Practice Address - Street 1:5400 LOCKHAVEN DR
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-1538
Practice Address - Country:US
Practice Address - Phone:562-292-5314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist