Provider Demographics
NPI:1710923750
Name:MEHTA, MINESH (MD, CCFP)
Entity Type:Individual
Prefix:DR
First Name:MINESH
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD, CCFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 E CARSON ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2262
Mailing Address - Country:US
Mailing Address - Phone:310-793-3520
Mailing Address - Fax:310-830-6621
Practice Address - Street 1:824 E CARSON ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2262
Practice Address - Country:US
Practice Address - Phone:310-793-3520
Practice Address - Fax:310-830-6621
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA062994207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG69176Medicare UPIN