MEDICARE: ARJUN PATEL MPH

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1568015790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARJUN PATEL MPH

Provider Business Mailing Address
First Line	:	1465 STONEHAVEN CT
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-8489
Country	:	US
Telephone Number	:	951-505-3664
Fax Number	:

Provider Business Practice Location Address
First Line	:	17130 VAN BUREN BLVD STE 231
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-5905
Country	:	US
Telephone Number	:	951-441-7649
Fax Number	:

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

Provider Enumeration Date	:	07/17/2019
Last Update Date	:	07/17/2019

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