Healthcare Provider Details

I. General information

NPI: 1295121978
Provider Name (Legal Business Name): DR SUNIL PATEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 BESSIE AVE
TRACY CA
95376-3417
US

IV. Provider business mailing address

1470 BESSIE AVE
TRACY CA
95376-3417
US

V. Phone/Fax

Practice location:
  • Phone: 209-833-0525
  • Fax: 209-830-7361
Mailing address:
  • Phone: 209-833-0525
  • Fax: 209-830-7361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA43957
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA43957
License Number StateCA

VIII. Authorized Official

Name: DR. SUNIL H PATEL
Title or Position: OWNER
Credential: M.D.
Phone: 209-833-0525