Healthcare Provider Details

I. General information

NPI: 1205512209
Provider Name (Legal Business Name): POOJA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 S SANDERSON AVE
HEMET CA
92545-9047
US

IV. Provider business mailing address

345 E 24TH ST
NEW YORK NY
10010-4020
US

V. Phone/Fax

Practice location:
  • Phone: 951-404-5307
  • Fax:
Mailing address:
  • Phone: 212-998-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: