Healthcare Provider Details

I. General information

NPI: 1295969343
Provider Name (Legal Business Name): PAYAL S PATEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 12/06/2021
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WILLARD
IRVINE CA
92604-4694
US

IV. Provider business mailing address

6 WILLARD
IRVINE CA
92604-4694
US

V. Phone/Fax

Practice location:
  • Phone: 949-262-5647
  • Fax:
Mailing address:
  • Phone: 949-262-5647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC154402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: