Healthcare Provider Details

I. General information

NPI: 1649406505
Provider Name (Legal Business Name): N AND B PATEL M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2009
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 WILSHIRE BLVD STE 801
LOS ANGELES CA
90057-3507
US

IV. Provider business mailing address

12400 VENTURA BLVD STE 1199
STUDIO CITY CA
91604-2406
US

V. Phone/Fax

Practice location:
  • Phone: 213-483-6322
  • Fax: 213-484-6317
Mailing address:
  • Phone: 213-483-6322
  • Fax: 213-484-6317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA36597
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA34922
License Number StateCA

VIII. Authorized Official

Name: NINNA PATEL
Title or Position: OWNER
Credential: M D
Phone: 213-483-6322