Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 34612 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | 34612 | CA |
NPI | 1053586800 |
---|---|
Provider Name | Binoy Govindbhai Patel |
First Address | Temecula, CA 92592-6816 |
Second Address | Menifee, CA 92586 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2008 |
Last Update Date | 16/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0PT346120 | BLUE SHIELD OF CALIFORNIA (01) | CA |