Provider Demographics
NPI:1750568275
Name:MEHTA, ALISON MILLER (DO)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:MILLER
Last Name:MEHTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ALISON
Other - Middle Name:ELIZABETH
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:999 BAKER WAY STE 420
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1582
Mailing Address - Country:US
Mailing Address - Phone:650-571-9652
Mailing Address - Fax:650-571-9657
Practice Address - Street 1:999 BAKER WAY STE 420
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94404-1582
Practice Address - Country:US
Practice Address - Phone:650-571-9652
Practice Address - Fax:650-571-9657
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2361802084P0800X
CA20A152342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001094301Medicare PIN