Healthcare Provider Details

I. General information

NPI: 1376937656
Provider Name (Legal Business Name): SHRUTI PRAVINKUMAR PATEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V ST # 1110
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

11823 GALVANI ST
LAS VEGAS NV
89183-5530
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA146173
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: