Healthcare Provider Details

I. General information

NPI: 1356327316
Provider Name (Legal Business Name): HITENDRA PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 HEALTH SCIENCES DR
LA JOLLA CA
92093-2640
US

IV. Provider business mailing address

PO BOX 232410 STE 800
SAN DIEGO CA
92193-2410
US

V. Phone/Fax

Practice location:
  • Phone: 858-822-3115
  • Fax:
Mailing address:
  • Phone: 619-543-6164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2004032535
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberC14440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: