Healthcare Provider Details

I. General information

NPI: 1568550127
Provider Name (Legal Business Name): SANJAY R. PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11030 N. TATUM BLVD BLDG F, SUITE 101
PHOENIX AZ
85028
US

IV. Provider business mailing address

11030 N. TATUM BLVD BLDG F, SUITE 101
PHOENIX AZ
85028
US

V. Phone/Fax

Practice location:
  • Phone: 602-889-9880
  • Fax: 480-304-9328
Mailing address:
  • Phone: 602-889-9880
  • Fax: 480-304-9328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberG80499
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number40721
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberU6548
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: