Healthcare Provider Details

I. General information

NPI: 1699726760
Provider Name (Legal Business Name): SUNIL K. PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3390 UNIVERSITY AVE STE 100
RIVERSIDE CA
92501-3315
US

IV. Provider business mailing address

3390 UNIVERSITY AVE STE 100
RIVERSIDE CA
92501-3315
US

V. Phone/Fax

Practice location:
  • Phone: 844-827-8000
  • Fax: 951-335-0058
Mailing address:
  • Phone: 844-827-8000
  • Fax: 951-335-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA51068
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: