Basic Information
Provider Information
NPI: 1235429432
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATEL
FirstName: KALPESH
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3003 WOODSIDE TER
Address2:  
City: FREMONT
State: CA
PostalCode: 945398071
CountryCode: US
TelephoneNumber: 4086613402
FaxNumber:  
Practice Location
Address1: 500 MAIN ST
Address2:  
City: LIVINGSTON
State: CA
PostalCode: 953341428
CountryCode: US
TelephoneNumber: 2093948416
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/10/2011
LastUpdateDate: 04/10/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X45015CAY Pharmacy Service ProvidersPharmacist 

No ID Information.


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