Provider Demographics
NPI:1053601369
Name:PATRI, JYOTHI RANGA (MD, MHA)
Entity type:Individual
Prefix:MS
First Name:JYOTHI RANGA
Middle Name:
Last Name:PATRI
Suffix:
Gender:F
Credentials:MD, MHA
Other - Prefix:
Other - First Name:RANGA JYOTHI
Other - Middle Name:
Other - Last Name:PATRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MHA
Mailing Address - Street 1:2625 E DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1431
Mailing Address - Country:US
Mailing Address - Phone:559-443-2682
Mailing Address - Fax:559-443-2681
Practice Address - Street 1:2740 HERNDON AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6813
Practice Address - Country:US
Practice Address - Phone:559-299-2578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD456265207Q00000X, 207Q00000X
CAC163119207Q00000X
TXQ0535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX345520601Medicaid
TX387573YPFLMedicare PIN