Healthcare Provider Details

I. General information

NPI: 1316297989
Provider Name (Legal Business Name): MAYURI PATEL RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 WHITTIER BLVD
LOS ANGELES CA
90023-2440
US

IV. Provider business mailing address

8935 LONG BEACH BLVD
SOUTH GATE CA
90280-2856
US

V. Phone/Fax

Practice location:
  • Phone: 323-265-1998
  • Fax:
Mailing address:
  • Phone: 562-547-3476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number930301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: