Healthcare Provider Details

I. General information

NPI: 1356280721
Provider Name (Legal Business Name): RAINA KUSHAL PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

5574 SNOWDON PL
SAN JOSE CA
95138-2356
US

V. Phone/Fax

Practice location:
  • Phone: 408-821-6442
  • Fax:
Mailing address:
  • Phone: 408-821-6442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number2086S0122X
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: