Healthcare Provider Details

I. General information

NPI: 1710564752
Provider Name (Legal Business Name): NIKITA SATAPATHY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19091 AZUL LN
HUNTINGTON BEACH CA
92648-2205
US

IV. Provider business mailing address

7790 W QUESTA DR
PEORIA AZ
85383-1872
US

V. Phone/Fax

Practice location:
  • Phone: 623-203-2920
  • Fax:
Mailing address:
  • Phone: 623-203-2920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number20A22858
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: