Healthcare Provider Details

I. General information

NPI: 1447945142
Provider Name (Legal Business Name): PRACHI PATEL M.B.B.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OPTUM 2 W. FERN AVE
REDLANDS CA
92373
US

IV. Provider business mailing address

11019 64TH AVE
FOREST HILLS NY
11375-1428
US

V. Phone/Fax

Practice location:
  • Phone: 909-335-4102
  • Fax:
Mailing address:
  • Phone: 917-683-3053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA210535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: