Provider Demographics
NPI:1134294473
Name:ATA O. MEHRTASH M.D. P.C.
Entity Type:Organization
Organization Name:ATA O. MEHRTASH M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ATA
Authorized Official - Middle Name:O
Authorized Official - Last Name:MEHRTASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-776-2390
Mailing Address - Street 1:1491 E LA PALMA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-1564
Mailing Address - Country:US
Mailing Address - Phone:714-776-2390
Mailing Address - Fax:714-776-3287
Practice Address - Street 1:1491 E LA PALMA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-1564
Practice Address - Country:US
Practice Address - Phone:714-776-2390
Practice Address - Fax:714-776-3287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38016207V00000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Not Answered207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty