Provider Demographics
NPI:1548486756
Name:PATEL, MOHMEDALI I (M D)
Entity type:Individual
Prefix:DR
First Name:MOHMEDALI
Middle Name:I
Last Name:PATEL
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16738,LAKESHORE DRIVE
Mailing Address - Street 2:SUITE-F
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4933
Mailing Address - Country:US
Mailing Address - Phone:951-674-6876
Mailing Address - Fax:951-674-6876
Practice Address - Street 1:16738 LAKESHORE DR
Practice Address - Street 2:SUITE-F
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4930
Practice Address - Country:US
Practice Address - Phone:951-674-6876
Practice Address - Fax:951-674-6876
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50401207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A5040Medicare ID - Type Unspecified