Provider Demographics
NPI:1437150299
Name:MEHTA, SANJAY R (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:R
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9500 GILMAN DR # MC0711
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-5004
Mailing Address - Country:US
Mailing Address - Phone:858-822-0333
Mailing Address - Fax:858-822-5362
Practice Address - Street 1:9500 GILMAN DR # MC0711
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-5004
Practice Address - Country:US
Practice Address - Phone:858-822-0333
Practice Address - Fax:858-822-5362
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A897140Medicaid
CA00A897140Medicaid
WA89714AMedicare PIN