Provider Demographics
NPI:1770112039
Name:VIVEK A MEHTA MD INC
Entity type:Organization
Organization Name:VIVEK A MEHTA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVEK
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-388-7190
Mailing Address - Street 1:PO BOX 2013
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-1013
Mailing Address - Country:US
Mailing Address - Phone:493-887-7190
Mailing Address - Fax:949-388-7150
Practice Address - Street 1:26732 CROWN VALLEY PKWY STE 541
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6376
Practice Address - Country:US
Practice Address - Phone:949-388-7190
Practice Address - Fax:949-388-7150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-07
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA125599OtherA125599