Provider Demographics
NPI:1629268073
Name:MINAL MEHTA, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MINAL MEHTA, A PROFESSIONAL CORPORATION
Other - Org Name:SOCAL OBGYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MINAL
Authorized Official - Middle Name:GUNVANTRAY
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-848-2383
Mailing Address - Street 1:18111 BROOKHURST ST #4450
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
Mailing Address - Country:US
Mailing Address - Phone:714-848-2383
Mailing Address - Fax:714-848-4083
Practice Address - Street 1:18111 BROOKHURST ST #4450
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-848-2383
Practice Address - Fax:714-848-4083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79701207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A797010Medicaid
CAH70654Medicare UPIN