Healthcare Provider Details

I. General information

NPI: 1124997812
Provider Name (Legal Business Name): LOTUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2025
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 RODEO PARK DR E UNIT 5
SANTA FE NM
87505-6312
US

IV. Provider business mailing address

3480 TODOS SANTOS ST APT C304
SANTA FE NM
87507-6212
US

V. Phone/Fax

Practice location:
  • Phone: 505-416-8484
  • Fax: 505-702-8556
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: TRISHA JAYANTILAL PATEL
Title or Position: MD
Credential:
Phone: 903-815-0274