Provider Demographics
NPI:1053573519
Name:PATEL, HITESH K (MD)
Entity type:Individual
Prefix:
First Name:HITESH
Middle Name:K
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 1:638 CAMINO DE LOS MARES STE D4
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2855
Mailing Address - Country:US
Mailing Address - Phone:949-542-8865
Mailing Address - Fax:949-276-2367
Practice Address - Street 1:638 CAMINO DE LOS MARES STE D4
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2855
Practice Address - Country:US
Practice Address - Phone:949-542-8865
Practice Address - Fax:949-276-2367
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111753207T00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHL742ZMedicare PIN