Healthcare Provider Details

I. General information

NPI: 1356089213
Provider Name (Legal Business Name): USHMA PATADIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2022
Last Update Date: 04/20/2024
Certification Date: 04/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 W GRANT LINE RD STE 220
TRACY CA
95377-7333
US

IV. Provider business mailing address

739 ALDEN LN
LIVERMORE CA
94550-4752
US

V. Phone/Fax

Practice location:
  • Phone: 209-835-8754
  • Fax:
Mailing address:
  • Phone: 860-899-8355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number109081
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: