Healthcare Provider Details

I. General information

NPI: 1821072505
Provider Name (Legal Business Name): MANDAKINI D PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 N JACKSON AVE STE 210
SAN JOSE CA
95116-1909
US

IV. Provider business mailing address

175 N JACKSON AVE STE 210
SAN JOSE CA
95116-1909
US

V. Phone/Fax

Practice location:
  • Phone: 408-729-1220
  • Fax:
Mailing address:
  • Phone: 408-729-1220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA41030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: