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General NPI Number Information
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NPI Number | 1487765376
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Entity Type | Individual
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Provider Name | SHIRISH BAVAJIBHAI PATEL M.D
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 3650 E. SOUTH ST SUITE 106
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City | LAKEWOOD
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State | CA
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Zip | 90712-1532
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Country | US
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Telephone | 562-925-7401
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Fax | 105-554-4045
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Provider Business Mailing Address
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Address Line | 3650 SOUTH ST STE 106
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City | LAKEWOOD
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State | CA
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Zip | 90712-1532
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Country | US
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Telephone | 562-925-7401
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Fax | 310-554-4045
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A0040789
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License Number State | CA
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