Basic Information
Provider Information
NPI: 1922430610
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATEL
FirstName: NEELAM
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3701 WILSHIRE BLVD
Address2: SUITE #600
City: LOS ANGELES
State: CA
PostalCode: 900102804
CountryCode: US
TelephoneNumber: 3233613550
FaxNumber: 3233618052
Practice Location
Address1: 4650 W SUNSET BLVD
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900276062
CountryCode: US
TelephoneNumber: 3233614100
FaxNumber: 3233613642
Other Information
ProviderEnumerationDate: 08/05/2013
LastUpdateDate: 04/27/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207PP0204XA141217CAY Allopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
208000000X25MA09357600NJN Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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