Healthcare Provider Details

I. General information

NPI: 1003254202
Provider Name (Legal Business Name): PRACHI TONI PATEL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 W VISTA WAY STE D
VISTA CA
92083-6030
US

IV. Provider business mailing address

2023 W VISTA WAY STE D
VISTA CA
92083-6030
US

V. Phone/Fax

Practice location:
  • Phone: 303-415-4157
  • Fax: 303-776-3109
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A18778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: