Healthcare Provider Details

I. General information

NPI: 1053573519
Provider Name (Legal Business Name): HITESH K. PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 CAMINO DE LOS MARES STE D4
SAN CLEMENTE CA
92673-2855
US

IV. Provider business mailing address

638 CAMINO DE LOS MARES STE D4
SAN CLEMENTE CA
92673-2855
US

V. Phone/Fax

Practice location:
  • Phone: 949-542-8865
  • Fax: 949-276-2367
Mailing address:
  • Phone: 949-542-8865
  • Fax: 949-276-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA111753
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA111753
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: