Provider Demographics
NPI:1174163125
Name:PATEL, AJITA (DOCTOR OF AYURVEDA)
Entity type:Individual
Prefix:DR
First Name:AJITA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DOCTOR OF AYURVEDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26524 AVENIDA VERONICA
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-3331
Mailing Address - Country:US
Mailing Address - Phone:949-207-8725
Mailing Address - Fax:
Practice Address - Street 1:505 W 1ST ST
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3004
Practice Address - Country:US
Practice Address - Phone:949-207-8725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18367674174H00000X, 246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No174H00000XOther Service ProvidersHealth Educator