Healthcare Provider Details

I. General information

NPI: 1780111989
Provider Name (Legal Business Name): RUGVED SHRIKANT PATTARKINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 06/11/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE
LOS ANGELES CA
90095-1530
US

IV. Provider business mailing address

91 HINDUSTAN COLONY WARDHA ROAD
NAGPUR MAHARASHTRA
440015
IN

V. Phone/Fax

Practice location:
  • Phone: 310-267-1900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: