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General NPI Number Information
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NPI Number | 1659839801
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Entity Type | Individual
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Provider Name | PRATIK U PATEL PSY. D.
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Gender | Male
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Dates
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Enumeration Date | 03/06/2019
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Last Update Date | 11/11/2021
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Provider Practice Location Address
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Address Line | 23986 ALISO CREEK RD # 210
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-3908
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Country | US
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Telephone | 323-489-5880
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Fax |
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Provider Business Mailing Address
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Address Line | 23986 ALISO CREEK RD # 210
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-3908
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Country | US
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Telephone | 323-489-5880
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 30800
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License Number State | CA
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