Healthcare Provider Details

I. General information

NPI: 1497739593
Provider Name (Legal Business Name): JAGDISH M PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W BASTANCHURY RD #130
FULLERTON CA
92835-3419
US

IV. Provider business mailing address

17868 US HIGHWAY 18 #358
APPLE VALLEY CA
92307-1267
US

V. Phone/Fax

Practice location:
  • Phone: 714-278-9363
  • Fax: 714-278-9364
Mailing address:
  • Phone: 714-278-9363
  • Fax: 714-278-9364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA32743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: