Healthcare Provider Details

I. General information

NPI: 1164452322
Provider Name (Legal Business Name): DR DINETH KANTILAL PATEL MD A CALIFORNIA MEDICAL COPRPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 TALBERT AVE SUITE 203
FOUNTAIN VALLEY CA
92708
US

IV. Provider business mailing address

9900 TALBERT AVE SUITE 203
FOUNTAIN VALLEY CA
92708
US

V. Phone/Fax

Practice location:
  • Phone: 714-378-7010
  • Fax: 714-378-5504
Mailing address:
  • Phone: 714-378-7010
  • Fax: 714-378-5504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA67079
License Number StateCA

VIII. Authorized Official

Name: DINESH KANTILAL PATEL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-378-7010