Healthcare Provider Details

I. General information

NPI: 1912306861
Provider Name (Legal Business Name): REEKESHRPATELMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2014
Last Update Date: 08/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W EL MOLINO ST
BLOOMINGTON CA
92316-2151
US

IV. Provider business mailing address

720 W EL MOLINO ST
BLOOMINGTON CA
92316-2151
US

V. Phone/Fax

Practice location:
  • Phone: 909-965-2953
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License NumberA126035
License Number StateCA

VIII. Authorized Official

Name: REEKESH PATEL
Title or Position: PRESIDENT
Credential:
Phone: 909-965-2953