Raj Patel
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Crockett, CA
NPI 1508396409 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1508396409
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- License
- 102841 (CA)
- Practice address
- 1099 Pomona St
Crockett, CA 94525-1427 - Phone
- (510) 787-1081
- NPI assigned
- Jun 14, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 102841 | CA | MD | Student in an Organized Health Care Education/Training Program |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bay Area Community Resources, Inc | Past | Accepting new patients | |
| Bay Area Community Resources, Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | 102841 | CA | Yes |
Addresses
Primary practice location
1099 Pomona St
Crockett, CA 94525-1427
Mailing address
3219 Pierce St
Richmond, CA 94804-5910
Phone (510) 559-5550
Other practice location 1
1731 Prince St
Berkeley, CA 94703-2464
Phone (510) 644-6313
Other providers in Crockett, CA
- Carrie McCluer
- Sonja Phyllis New
- John The Phong Nguyen
- Kevin Bernard Noonan
- Elizabeth Marie Oberholtzer
- Sophia A Reiff
- Dennis G Rolley
- Daniel Paul Ross
- Seneca Family of Agencies
- Mervyn Frank Silverman
All providers in Crockett, CA · Student in an Organized Health Care Education/Training Program in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.