Healthcare Provider Details

I. General information

NPI: 1902554256
Provider Name (Legal Business Name): REEMA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 CLUB DR
VALLEJO CA
94592-1187
US

IV. Provider business mailing address

101 THE CITY DR S STE 400
ORANGE CA
92868-3201
US

V. Phone/Fax

Practice location:
  • Phone: 707-638-5200
  • Fax:
Mailing address:
  • Phone: 714-456-5691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: