Provider Demographics
NPI:1821704321
Name:PRATIK MEHTA M.D., INC.
Entity Type:Organization
Organization Name:PRATIK MEHTA M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PRATIK
Authorized Official - Middle Name:ASHOK
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-293-8274
Mailing Address - Street 1:9854 NATIONAL BLVD # 1233
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-2713
Mailing Address - Country:US
Mailing Address - Phone:818-293-8274
Mailing Address - Fax:
Practice Address - Street 1:10323 SANTA MONICA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5056
Practice Address - Country:US
Practice Address - Phone:818-293-8274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty