Healthcare Provider Details

I. General information

NPI: 1023671260
Provider Name (Legal Business Name): PUNAM PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2019
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W 190TH ST STE 280
GARDENA CA
90248-4305
US

IV. Provider business mailing address

15544 W COLONIAL DR
WINTER GARDEN FL
34787-9556
US

V. Phone/Fax

Practice location:
  • Phone: 877-515-8113
  • Fax:
Mailing address:
  • Phone: 800-457-4573
  • Fax: 800-443-6422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME163945
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: