Healthcare Provider Details

I. General information

NPI: 1497093678
Provider Name (Legal Business Name): USHMA PATEL RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 BAY RD
EAST PALO ALTO CA
94303-1312
US

IV. Provider business mailing address

5402 PORT SAILWOOD DR
NEWARK CA
94560-2668
US

V. Phone/Fax

Practice location:
  • Phone: 650-289-7700
  • Fax:
Mailing address:
  • Phone: 203-376-9045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH 25744
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDHAP 515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: