Provider Demographics
NPI:1639778673
Name:MEHTA, DEEPAK (MD)
Entity type:Individual
Prefix:
First Name:DEEPAK
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C/O MEDICAL STAFF OFFICE
Mailing Address - Street 2:CMF
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95697
Mailing Address - Country:US
Mailing Address - Phone:707-718-3427
Mailing Address - Fax:
Practice Address - Street 1:C/O MEDICAL STAFF OFFICE
Practice Address - Street 2:CMF
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95696
Practice Address - Country:US
Practice Address - Phone:707-453-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63312207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine