Healthcare Provider Details

I. General information

NPI: 1104817147
Provider Name (Legal Business Name): RENUKA NARAIN PATEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18837 BROOKHURST ST STE 110
FOUNTAIN VALLEY CA
92708-7301
US

IV. Provider business mailing address

1916 W BEVERLY DR
ORANGE CA
92868-2021
US

V. Phone/Fax

Practice location:
  • Phone: 314-246-0394
  • Fax:
Mailing address:
  • Phone: 314-775-3697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC181973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: