Healthcare Provider Details

I. General information

NPI: 1578065199
Provider Name (Legal Business Name): KAVITA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2262 N 1ST ST
SAN JOSE CA
95131-2022
US

IV. Provider business mailing address

39420 LIBERTY ST STE 150
FREMONT CA
94538-2284
US

V. Phone/Fax

Practice location:
  • Phone: 408-337-2727
  • Fax:
Mailing address:
  • Phone: 510-794-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number23802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: