Healthcare Provider Details

I. General information

NPI: 1174704126
Provider Name (Legal Business Name): JYOTIN K PATEL M,D. A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30110 CROWN VALLEY PKWY STE 101
LAGUNA NIGUEL CA
92677-2043
US

IV. Provider business mailing address

30110 CROWN VALLEY PKWY SUITE 101
LAGUNA NIGUEL CA
92677-2043
US

V. Phone/Fax

Practice location:
  • Phone: 949-363-5322
  • Fax:
Mailing address:
  • Phone: 949-363-5322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JYOTIN K PATEL
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 949-363-5322