Healthcare Provider Details

I. General information

NPI: 1174163125
Provider Name (Legal Business Name): AJITA PATEL DOCTOR OF AYURVEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W 1ST ST
TUSTIN CA
92780-3004
US

IV. Provider business mailing address

26524 AVENIDA VERONICA
MISSION VIEJO CA
92691-3331
US

V. Phone/Fax

Practice location:
  • Phone: 949-207-8725
  • Fax:
Mailing address:
  • Phone: 949-207-8725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number18367674
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number18367674
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: