Healthcare Provider Details

I. General information

NPI: 1346765666
Provider Name (Legal Business Name): YOGESH PATEL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 08/28/2022
Certification Date: 08/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3665 S 8400 W
MAGNA UT
84044-4907
US

IV. Provider business mailing address

662 W DEEPDALE CT
STANSBURY PARK UT
84074-5593
US

V. Phone/Fax

Practice location:
  • Phone: 801-250-9638
  • Fax:
Mailing address:
  • Phone: 480-388-7256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10514922-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: