Healthcare Provider Details

I. General information

NPI: 1982858809
Provider Name (Legal Business Name): TRUSHAR JAYANTI PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOAG DR
NEWPORT BEACH CA
92663-4162
US

IV. Provider business mailing address

471 OLD NEWPORT BLVD STE 302
NEWPORT BEACH CA
92663-4244
US

V. Phone/Fax

Practice location:
  • Phone: 949-645-3534
  • Fax:
Mailing address:
  • Phone: 949-263-8620
  • Fax: 800-409-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA117321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: