Healthcare Provider Details

I. General information

NPI: 1881691269
Provider Name (Legal Business Name): NISHITA SOMABHAI PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 E 2ND ST STE 5
POMONA CA
91766-2007
US

IV. Provider business mailing address

795 E. SECOND STREET SUITE 5
POMONA CA
91766-2007
US

V. Phone/Fax

Practice location:
  • Phone: 909-706-8332
  • Fax: 909-706-3785
Mailing address:
  • Phone: 909-706-8332
  • Fax: 909-706-3785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA113143
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: