Healthcare Provider Details

I. General information

NPI: 1861806754
Provider Name (Legal Business Name): NIMA PATEL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SCOFIELD AVE WASCO STATE PRISON
WASCO CA
93280
US

IV. Provider business mailing address

5405 VIA VENEZIA
BAKERSFIELD CA
93306-9562
US

V. Phone/Fax

Practice location:
  • Phone: 661-758-8400
  • Fax:
Mailing address:
  • Phone: 661-758-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY21666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: