Healthcare Provider Details

I. General information

NPI: 1497619779
Provider Name (Legal Business Name): KOMALBEN PATEL PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 NEVADA ST
REDLANDS CA
92374-2957
US

IV. Provider business mailing address

1030 NEVADA ST STE 101
REDLANDS CA
92374-2957
US

V. Phone/Fax

Practice location:
  • Phone: 909-966-5500
  • Fax: 909-966-5222
Mailing address:
  • Phone: 562-659-0671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95037902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: