Provider Demographics
NPI:1477583912
Name:MEHTANI, SNEH L (DPM)
Entity type:Individual
Prefix:
First Name:SNEH
Middle Name:L
Last Name:MEHTANI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-0655
Mailing Address - Country:US
Mailing Address - Phone:951-642-1059
Mailing Address - Fax:951-848-9695
Practice Address - Street 1:3722 TIBBETTS ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2605
Practice Address - Country:US
Practice Address - Phone:951-642-1059
Practice Address - Fax:951-848-9695
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4477213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5588390002Medicare NSC
CAU95622Medicare UPIN