Healthcare Provider Details

I. General information

NPI: 1891160503
Provider Name (Legal Business Name): CHIRAG PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 10/12/2023
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 COUNTRY CLUB DR STE E
MADERA CA
93638-2691
US

IV. Provider business mailing address

1830 ASHLAN AVE
CLOVIS CA
93611
US

V. Phone/Fax

Practice location:
  • Phone: 559-664-4000
  • Fax: 559-675-5224
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: