Healthcare Provider Details

I. General information

NPI: 1033479100
Provider Name (Legal Business Name): JAY NITIN PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 WESTCLIFF DR STE 201
NEWPORT BEACH CA
92660-5518
US

IV. Provider business mailing address

1501 WESTCLIFF DR STE 201
NEWPORT BEACH CA
92660-5518
US

V. Phone/Fax

Practice location:
  • Phone: 949-629-3380
  • Fax: 949-629-3085
Mailing address:
  • Phone: 949-629-3380
  • Fax: 949-629-3085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number036137857
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberA163312
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036137857
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number036137857
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA163312
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA163312
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036137857
License Number StateIL
# 8
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberA163312
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: