Provider Demographics
NPI:1710007786
Name:KHUSAL MEHTA RURAL HEALTH CLINIC
Entity Type:Organization
Organization Name:KHUSAL MEHTA RURAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KHUSAL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-591-1060
Mailing Address - Street 1:430 N VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-1631
Mailing Address - Country:US
Mailing Address - Phone:559-591-1060
Mailing Address - Fax:
Practice Address - Street 1:430 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-1631
Practice Address - Country:US
Practice Address - Phone:559-591-1060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-31
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0A360470261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health