Healthcare Provider Details

I. General information

NPI: 1912972795
Provider Name (Legal Business Name): PRATIBHA ASHOKKUMAR PATEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 W 190TH ST
TORRANCE CA
90504-6103
US

IV. Provider business mailing address

4206 E LA PALMA AVE
ANAHEIM CA
92807-1816
US

V. Phone/Fax

Practice location:
  • Phone: 310-783-5510
  • Fax: 310-783-5597
Mailing address:
  • Phone: 562-988-7296
  • Fax: 562-988-7400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA 31386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: