MEDICARE: PUJA PATEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		AZ

General Provider Information

NPI Number	:	1528859451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PUJA PATEL

Provider Business Mailing Address
First Line	:	1301 S CRISMON RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85209-3767
Country	:	US
Telephone Number	:	480-373-2376
Fax Number	:	480-358-6171

Provider Business Practice Location Address
First Line	:	10238 E HAMPTON AVE STE 411
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85209-3320
Country	:	US
Telephone Number	:	480-882-4750
Fax Number	:	480-882-5076

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2025
Last Update Date	:	05/12/2025

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Directions to “ PUJA PATEL ” Practice Location

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