Provider Demographics
NPI: | 1639250228 |
---|---|
Name: | MEHTA, NILIMA |
Entity Type: | Individual |
Prefix: | DR |
First Name: | NILIMA |
Middle Name: | |
Last Name: | MEHTA |
Suffix: | |
Gender: | F |
Credentials: | |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 4110 GUADALUPE ST |
Mailing Address - Street 2: | ATTN: REIMBURSEMENT DEPT |
Mailing Address - City: | AUSTIN |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78751-4223 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4110 GUADALUPE ST |
Practice Address - Street 2: | ATTN: REIMBURSEMENT DEPT |
Practice Address - City: | AUSTIN |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78751-4223 |
Practice Address - Country: | US |
Practice Address - Phone: | 512-419-2731 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-10-18 |
Last Update Date: | 2016-03-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | H2953 | 2084P0804X, 2084P0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 1367591 01 | Medicaid | |
TX | 1367591 01 | Medicaid | |
TX | E03426 | Medicare UPIN |