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General NPI Number Information
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NPI Number | 1063824183
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Entity Type | Organization
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Legal Business Name | REENA R PATEL MD INC
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Dates
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Enumeration Date | 05/22/2014
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 1108 FREMONT AVE
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-3227
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Country | US
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Telephone | 626-765-7852
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Fax | 626-606-3952
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Provider Business Mailing Address
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Address Line | 720 W EL MOLINO ST
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City | BLOOMINGTON
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State | CA
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Zip | 92316-2151
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Country | US
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Telephone | 909-991-5072
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Fax |
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Authorized Official
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Title or Position | FAMILY MEDICINE/OWNER
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Name | DR. REENA R PATEL
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Credential | MD
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Telephone | 909-991-5072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A109224
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License Number State | CA
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