Healthcare Provider Details

I. General information

NPI: 1144218488
Provider Name (Legal Business Name): RAM V PATAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 03/07/2023
Certification Date: 04/17/2020
Deactivation Date: 03/25/2006
Reactivation Date: 04/25/2006

III. Provider practice location address

18546 ROSCOE BLVD STE 110
NORTHRIDGE CA
91324-4667
US

IV. Provider business mailing address

18546 ROSCOE BLVD STE 110
NORTHRIDGE CA
91324-4667
US

V. Phone/Fax

Practice location:
  • Phone: 818-993-5600
  • Fax: 818-775-1509
Mailing address:
  • Phone: 818-993-5600
  • Fax: 818-775-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberC39711
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: