Healthcare Provider Details

I. General information

NPI: 1205234812
Provider Name (Legal Business Name): PRIYA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2014
Last Update Date: 12/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42021 FLORIDA AVE
HEMET CA
92544-5016
US

IV. Provider business mailing address

2153 NORTHAM DR
FULLERTON CA
92833-5651
US

V. Phone/Fax

Practice location:
  • Phone: 951-925-1651
  • Fax:
Mailing address:
  • Phone: 562-480-6997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71999
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: