Healthcare Provider Details

I. General information

NPI: 1992019046
Provider Name (Legal Business Name): DIPTI SHEETAL PATEL PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16491 LAKESHORE DR
LAKE ELSINORE CA
92530-6723
US

IV. Provider business mailing address

2120 SPRINGFIELD CIR
CORONA CA
92879-2856
US

V. Phone/Fax

Practice location:
  • Phone: 951-674-0309
  • Fax: 951-674-0419
Mailing address:
  • Phone: 714-697-7655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number55240
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: