Healthcare Provider Details

I. General information

NPI: 1083369151
Provider Name (Legal Business Name): NISHA PATEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10861 CHERRY ST STE 104
LOS ALAMITOS CA
90720-5403
US

IV. Provider business mailing address

10861 CHERRY ST STE 104
LOS ALAMITOS CA
90720-5403
US

V. Phone/Fax

Practice location:
  • Phone: 562-794-9801
  • Fax:
Mailing address:
  • Phone: 562-794-9801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95020607
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number95262590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: