Provider Demographics
NPI:1679657043
Name:MEHROTRA, NIDHI (MD)
Entity Type:Individual
Prefix:
First Name:NIDHI
Middle Name:
Last Name:MEHROTRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6769 N WILLOW AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5900
Mailing Address - Country:US
Mailing Address - Phone:559-325-2400
Mailing Address - Fax:888-611-8817
Practice Address - Street 1:6769 N WILLOW AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5900
Practice Address - Country:US
Practice Address - Phone:559-325-2400
Practice Address - Fax:888-611-8817
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72677208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A726770Medicaid
A072677OtherHEALTH NET MEDI- CAL
CA00A726770Medicare ID - Type Unspecified
CA00A726770Medicaid
A072677OtherHEALTH NET MEDI- CAL