Healthcare Provider Details

I. General information

NPI: 1801597356
Provider Name (Legal Business Name): KRUPALIBEN PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

392 TESCONI CT
SANTA ROSA CA
95401-4653
US

IV. Provider business mailing address

392 TESCONI CT
SANTA ROSA CA
95401-4653
US

V. Phone/Fax

Practice location:
  • Phone: 229-740-5163
  • Fax:
Mailing address:
  • Phone: 229-740-5163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95034164
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95333355
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-185295
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: