Healthcare Provider Details

I. General information

NPI: 1053345926
Provider Name (Legal Business Name): NIKHIL C PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date: 11/16/2019
Reactivation Date: 12/11/2019

III. Provider practice location address

25485 MEDICAL CENTER DR STE 106
MURRIETA CA
92562-6927
US

IV. Provider business mailing address

25485 MEDICAL CENTER DR STE 106
MURRIETA CA
92562-6927
US

V. Phone/Fax

Practice location:
  • Phone: 585-755-0523
  • Fax: 951-574-6501
Mailing address:
  • Phone: 585-755-0523
  • Fax: 951-574-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number217302
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number217302
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number55916
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA71184
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: