Healthcare Provider Details

I. General information

NPI: 1356852461
Provider Name (Legal Business Name): HITAXI AMBALAL PATEL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CENTRAL AVE STE 145
RIVERSIDE CA
92506-2161
US

IV. Provider business mailing address

1845 BUSINESS CENTER DR STE 127
SAN BERNARDINO CA
92408-3434
US

V. Phone/Fax

Practice location:
  • Phone: 951-297-3399
  • Fax: 951-294-3404
Mailing address:
  • Phone: 909-890-9030
  • Fax: 909-890-4393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number298526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: