Healthcare Provider Details

I. General information

NPI: 1184809733
Provider Name (Legal Business Name): RITA PATEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11235 ANDERSON ST
LOMA LINDA CA
92354-2803
US

IV. Provider business mailing address

11235 ANDERSON ST
LOMA LINDA CA
92354-2803
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-8514
  • Fax:
Mailing address:
  • Phone: 909-558-8514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number17900
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number17900
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: