Provider Demographics
NPI:1831191105
Name:PATEL, RAJENDRA A (MD)
Entity type:Individual
Prefix:
First Name:RAJENDRA
Middle Name:A
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1139
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1139
Mailing Address - Country:US
Mailing Address - Phone:661-371-2796
Mailing Address - Fax:661-438-1746
Practice Address - Street 1:5925 TRUXTUN AVE STE A
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0433
Practice Address - Country:US
Practice Address - Phone:661-638-2273
Practice Address - Fax:661-638-2288
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A480980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770423693OtherTAX IDENTIFICATION NUMBER
CA00A480980Medicare PIN
CAE37058Medicare UPIN
CAZZZ01220ZMedicare ID - Type Unspecified
CA770423693OtherTAX IDENTIFICATION NUMBER