Basic Information
| Provider Information | |||||||||
| NPI: | 1396759817 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | NITA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1450 TREAT BLVD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945972168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259522888 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2400 BALFOUR RD | ||||||||
| Address2: | #229 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945134945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9253088113 | ||||||||
| FaxNumber: | 9253088701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 12/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD426585 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | C52978 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1396759817 | 05 | CA | MEDICAID |