Healthcare Provider Details

I. General information

NPI: 1932324647
Provider Name (Legal Business Name): VIMAL PATEL RPH, CCN, CAD, DIHOM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8952 E DESERT COVE AVE #103
SCOTTSDALE AZ
85260
US

IV. Provider business mailing address

15105 N 93RD WAY
SCOTTSDALE AZ
85260-2827
US

V. Phone/Fax

Practice location:
  • Phone: 480-767-7751
  • Fax: 480-767-7754
Mailing address:
  • Phone: 480-767-7751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number605
License Number State
# 2
Primary TaxonomyN
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number3130
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number3130
License Number State
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number3130
License Number State
# 5
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9492
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number605
License Number State
# 8
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number605
License Number State
# 9
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number9492
License Number StateAZ
# 10
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS009492
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: