Healthcare Provider Details

I. General information

NPI: 1982067062
Provider Name (Legal Business Name): SURENDRA PATEL MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 10/30/2021
Certification Date: 10/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5680 N FRESNO ST SUITE 101
FRESNO CA
93710-8331
US

IV. Provider business mailing address

5680 N FRESNO ST SUITE 101
FRESNO CA
93710-8331
US

V. Phone/Fax

Practice location:
  • Phone: 559-440-1110
  • Fax: 559-440-1114
Mailing address:
  • Phone: 559-440-1110
  • Fax: 559-440-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA50956
License Number StateCA

VIII. Authorized Official

Name: SURENDRA MOTIBHAI PATEL
Title or Position: CEO
Credential: MD
Phone: 559-440-1110