Provider Demographics
NPI:1770995466
Name:MEHIS, NICOLAS SHANE (DO)
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:SHANE
Last Name:MEHIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:18040 SHERMAN WAY STE 210
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4656
Mailing Address - Country:US
Mailing Address - Phone:818-796-2920
Mailing Address - Fax:702-399-8431
Practice Address - Street 1:18040 SHERMAN WAY STE 210
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4656
Practice Address - Country:US
Practice Address - Phone:818-796-2920
Practice Address - Fax:702-399-8431
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A15690207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty