Provider Demographics
NPI:1841272218
Name:PATEL, MANOJ KUMAR (MD)
Entity type:Individual
Prefix:
First Name:MANOJ
Middle Name:KUMAR
Last Name:PATEL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7117 BROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2658
Mailing Address - Country:US
Mailing Address - Phone:951-782-3789
Mailing Address - Fax:951-784-3275
Practice Address - Street 1:7117 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2615
Practice Address - Country:US
Practice Address - Phone:951-782-3789
Practice Address - Fax:951-784-3275
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52248207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ31887ZOtherGROUP SITE NUMBER
1730180415OtherGROUP NPI #
1730180415OtherGROUP NPI #
ZZZ31887ZOtherGROUP SITE NUMBER