Provider Demographics
NPI:1891070215
Name:MAHAL, JYOT
Entity Type:Individual
Prefix:DR
First Name:JYOT
Middle Name:
Last Name:MAHAL
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 1:4172 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-4312
Mailing Address - Country:US
Mailing Address - Phone:559-243-0124
Mailing Address - Fax:559-243-0313
Practice Address - Street 1:4172 N. 1ST ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-4312
Practice Address - Country:US
Practice Address - Phone:559-243-0124
Practice Address - Fax:559-243-0313
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist