Healthcare Provider Details

I. General information

NPI: 1720994361
Provider Name (Legal Business Name): AVI PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 E BETTERAVIA RD STE 201
SANTA MARIA CA
93454-7023
US

IV. Provider business mailing address

607 N BROADWAY
SANTA MARIA CA
93454-3751
US

V. Phone/Fax

Practice location:
  • Phone: 805-332-9704
  • Fax:
Mailing address:
  • Phone: 805-332-9704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: