Healthcare Provider Details

I. General information

NPI: 1245246511
Provider Name (Legal Business Name): NISHA PATEL DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 YGNACIO VALLEY RD SUITE #102
WALNUT CREEK CA
94598-3190
US

IV. Provider business mailing address

338 SPEAR ST UNIT 11B
SAN FRANCISCO CA
94105-6172
US

V. Phone/Fax

Practice location:
  • Phone: 925-476-2468
  • Fax: 925-476-1427
Mailing address:
  • Phone: 312-953-3053
  • Fax: 925-476-1427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: