Provider Demographics
NPI:1467505834
Name:MISTRY, CHETAN AMRITLAL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHETAN
Middle Name:AMRITLAL
Last Name:MISTRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 3RD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-1349
Mailing Address - Country:US
Mailing Address - Phone:619-426-7910
Mailing Address - Fax:619-426-4953
Practice Address - Street 1:865 3RD AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1349
Practice Address - Country:US
Practice Address - Phone:619-426-7910
Practice Address - Fax:619-426-4953
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97646208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics