Basic Information
| Provider Information | |||||||||
| NPI: | 1538626999 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | JAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11420 WARNER AVENUE | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145491300 | ||||||||
| FaxNumber: | 7144333100 | ||||||||
| Practice Location | |||||||||
| Address1: | 11420 WARNER AVENUE | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145491300 | ||||||||
| FaxNumber: | 7144333100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2019 | ||||||||
| LastUpdateDate: | 06/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A19492 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.