=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790916237
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANAHEIM MARKET CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2009
-----------------------------------------------------
Last Update Date | 07/31/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1311 S.ANAHEIM BLVD
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-635-6400
-----------------------------------------------------
Fax | 714-635-6433
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1311 S.ANAHEIM BLVD.
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-635-6400
-----------------------------------------------------
Fax | 714-635-6433
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. HITESH D PATEL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 714-635-6600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A50292
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------