Healthcare Provider Details

I. General information

NPI: 1518250760
Provider Name (Legal Business Name): KAVITA PATEL RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2011
Last Update Date: 05/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6215 SANTA TERESA BLVD
SAN JOSE CA
95119-1436
US

IV. Provider business mailing address

4924 EASTBOURNE CT
SAN JOSE CA
95138-2124
US

V. Phone/Fax

Practice location:
  • Phone: 408-227-2816
  • Fax:
Mailing address:
  • Phone: 408-270-2551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number49950
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP039885L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: