Provider Demographics
NPI:1043861701
Name:PATEL, ANJU (RD)
Entity type:Individual
Prefix:
First Name:ANJU
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5651 N PASEO NIQUEL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-3922
Mailing Address - Country:US
Mailing Address - Phone:520-990-4112
Mailing Address - Fax:
Practice Address - Street 1:5651 N PASEO NIQUEL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-3922
Practice Address - Country:US
Practice Address - Phone:520-990-4112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ991597Medicaid