Healthcare Provider Details

I. General information

NPI: 1902399231
Provider Name (Legal Business Name): NISHANT U PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 CONANT AVE
MODESTO CA
95350-6527
US

IV. Provider business mailing address

3125 CONANT AVE
MODESTO CA
95350-6527
US

V. Phone/Fax

Practice location:
  • Phone: 209-524-1668
  • Fax: 209-524-0014
Mailing address:
  • Phone: 209-524-1668
  • Fax: 209-524-0014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11019792A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number173856
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: