Healthcare Provider Details

I. General information

NPI: 1962609073
Provider Name (Legal Business Name): SALONI PATEL RAO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SALONI DINESH PATEL D.O.

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CRAVEN RD KAISER PERMANENTE SAN MARCOS MEDICAL OFFICE
SAN MARCOS CA
92078-4201
US

IV. Provider business mailing address

5807 LOS ARCOS WAY
BUENA PARK CA
90620-2726
US

V. Phone/Fax

Practice location:
  • Phone: 800-290-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A10725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: