Healthcare Provider Details

I. General information

NPI: 1518369289
Provider Name (Legal Business Name): CALVIN PURUSHOTTAM PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3865 JACKSON ST STE. 106-526
RIVERSIDE CA
92503-3919
US

IV. Provider business mailing address

12223 HIGHLAND AVE 106-526
RANCHO CUCAMONGA CA
91739-2574
US

V. Phone/Fax

Practice location:
  • Phone: 951-688-2211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA132345
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA132345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: