Provider Demographics
NPI:1023054269
Name:PATEL, PURNIMA K (MD)
Entity type:Individual
Prefix:
First Name:PURNIMA
Middle Name:K
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36243 INLAND VALLEY DRIVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-9548
Mailing Address - Country:US
Mailing Address - Phone:951-698-8821
Mailing Address - Fax:951-677-3975
Practice Address - Street 1:36243 INLAND VALLEY DRIVE
Practice Address - Street 2:SUITE 160
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-9548
Practice Address - Country:US
Practice Address - Phone:951-698-8821
Practice Address - Fax:951-677-3975
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA32125207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A321250OtherMEDICARE PROVIDER ID
CA00A321250Medicaid
CA00A321250Medicaid