Provider Demographics
NPI:1497869770
Name:MEHRA, MINI (MD)
Entity Type:Individual
Prefix:DR
First Name:MINI
Middle Name:
Last Name:MEHRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3640 LOMITA BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3984
Mailing Address - Country:US
Mailing Address - Phone:562-933-6730
Mailing Address - Fax:562-933-6744
Practice Address - Street 1:1760 TERMINO AVE STE 300
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2157
Practice Address - Country:US
Practice Address - Phone:562-933-3009
Practice Address - Fax:562-933-8557
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA605912080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A605910Medicaid
CAGR0053510Medicaid
CA00A605910Medicaid
CAGR0053510Medicaid
CAH27917Medicare UPIN