Provider Demographics
NPI:1366743056
Name:PATEL, RITA (PA-C)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17350 ST LUKES WAY
Mailing Address - Street 2:STE 400
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4167
Mailing Address - Country:US
Mailing Address - Phone:281-444-3278
Mailing Address - Fax:
Practice Address - Street 1:6636 W WILLIAM CANNON DR
Practice Address - Street 2:APT 522
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8529
Practice Address - Country:US
Practice Address - Phone:410-207-9188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004311363AM0700X
TXPA08880363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical