Provider Demographics
NPI:1184725749
Name:MEHTA, RUCHA J (MD)
Entity type:Individual
Prefix:MRS
First Name:RUCHA
Middle Name:J
Last Name:MEHTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:RUCHA
Other - Middle Name:B
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:795 E 2ND ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2007
Mailing Address - Country:US
Mailing Address - Phone:909-706-3779
Mailing Address - Fax:909-865-2955
Practice Address - Street 1:795 E 2ND ST
Practice Address - Street 2:SUITE 4
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2007
Practice Address - Country:US
Practice Address - Phone:909-706-3779
Practice Address - Fax:909-865-2955
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC35693207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACL491ZMedicare PIN
CACL491YMedicare PIN