MEDICARE: KIRTI PATEL NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	95007091	CA

General Provider Information

NPI Number	:	1154833937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRTI PATEL NP

Provider Business Mailing Address
First Line	:	1411 N HIGHLAND AVE APT 408
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-9407
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2107 HILLHURST AVE APT 408
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-2003
Country	:	US
Telephone Number	:	323-664-0186
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2017
Last Update Date	:	01/15/2019

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