Provider Demographics
NPI:1912972795
Name:PATEL, PRATIBHA ASHOKKUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:PRATIBHA
Middle Name:ASHOKKUMAR
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 1:4206 E LA PALMA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-1816
Mailing Address - Country:US
Mailing Address - Phone:562-988-7296
Mailing Address - Fax:562-988-7400
Practice Address - Street 1:2160 W 190TH ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-6103
Practice Address - Country:US
Practice Address - Phone:310-783-5510
Practice Address - Fax:310-783-5597
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 31386208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics