Healthcare Provider Details

I. General information

NPI: 1255777439
Provider Name (Legal Business Name): HEMANSHU R PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 W MAIN ST STE 110
BARSTOW CA
92311-3726
US

IV. Provider business mailing address

19111 TOWN CENTER DR
APPLE VALLEY CA
92308-8989
US

V. Phone/Fax

Practice location:
  • Phone: 760-256-1422
  • Fax: 760-255-1066
Mailing address:
  • Phone: 760-242-7777
  • Fax: 888-847-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA143699
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: