Basic Information
| Provider Information | |||||||||
| NPI: | 1427079169 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | JAYESH | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1261 TRAVIS BLVD | ||||||||
| Address2: | STE. 320 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945334897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074232506 | ||||||||
| FaxNumber: | 7074254236 | ||||||||
| Practice Location | |||||||||
| Address1: | 1261 TRAVIS BLVD | ||||||||
| Address2: | STE. 320 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945334897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074232506 | ||||||||
| FaxNumber: | 7074254236 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 12/29/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A72056 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.