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General NPI Number Information
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NPI Number | 1386133759
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Entity Type | Individual
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Provider Name | DEVAK PATEL DO, MBA
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Gender | Male
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Dates
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Enumeration Date | 05/01/2018
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 2968 RODEO PARK DR W STE 150
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City | SANTA FE
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State | NM
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Zip | 87505-6383
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Country | US
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Telephone | 505-982-5014
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Fax | 505-982-2687
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Provider Business Mailing Address
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Address Line | 2968 RODEO PARK DR W STE 150
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City | SANTA FE
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State | NM
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Zip | 87505-6383
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Country | US
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Telephone | 505-982-5014
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Fax | 505-982-2687
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 20A21215
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | DO2024-0131
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License Number State | NM
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