Provider Demographics
NPI:1518904143
Name:MEHTA, PREETI (MD)
Entity Type:Individual
Prefix:
First Name:PREETI
Middle Name:
Last Name:MEHTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PREETI
Other - Middle Name:GURUPRASAD
Other - Last Name:SONNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9293 REGENTS RD
Mailing Address - Street 2:C-307
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-9170
Mailing Address - Country:US
Mailing Address - Phone:857-891-9971
Mailing Address - Fax:
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 900
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1224
Practice Address - Country:US
Practice Address - Phone:858-626-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98264207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A982640OtherMEDICAL
CAA98264OtherSTATE LICENSE
CAWA98264AOtherMEDICARE
CAA98264OtherSTATE LICENSE