Provider Demographics
NPI:1063853919
Name:MEHTA, PRATIK D (MD)
Entity Type:Individual
Prefix:
First Name:PRATIK
Middle Name:D
Last Name:MEHTA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:120 MAYFAIR
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2832
Mailing Address - Country:US
Mailing Address - Phone:949-357-7142
Mailing Address - Fax:209-468-7042
Practice Address - Street 1:120 MAYFAIR
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-2832
Practice Address - Country:US
Practice Address - Phone:949-357-7142
Practice Address - Fax:209-468-7042
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2021-09-24
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Provider Licenses
StateLicense IDTaxonomies
CAA139446208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery