Provider Demographics
NPI:1700855145
Name:PATEL, AVAN M (MD)
Entity type:Individual
Prefix:DR
First Name:AVAN
Middle Name:M
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-851-2462
Mailing Address - Fax:
Practice Address - Street 1:5051 VERDUGO WAY STE 100
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8681
Practice Address - Country:US
Practice Address - Phone:805-384-8071
Practice Address - Fax:805-897-1927
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA101189207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265456768Medicaid