Provider Demographics
NPI:1841528957
Name:TEJAS PATEL, MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:TEJAS PATEL, MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TEJAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:8188-078-7020
Mailing Address - Street 1:10061 RIVERSIDE DR
Mailing Address - Street 2:STE 167
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2560
Mailing Address - Country:US
Mailing Address - Phone:818-807-8702
Mailing Address - Fax:
Practice Address - Street 1:2625 W ALAMEDA AVE
Practice Address - Street 2:STE 412
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4806
Practice Address - Country:US
Practice Address - Phone:818-842-6400
Practice Address - Fax:818-842-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88498207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty