Provider Demographics
NPI:1841509064
Name:ANIL MEHTA MD INC
Entity type:Organization
Organization Name:ANIL MEHTA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORSYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-322-8466
Mailing Address - Street 1:3941 SAN DIMAS ST
Mailing Address - Street 2:104
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-5734
Mailing Address - Country:US
Mailing Address - Phone:661-322-8466
Mailing Address - Fax:661-322-5902
Practice Address - Street 1:3941 SAN DIMAS ST
Practice Address - Street 2:104
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5734
Practice Address - Country:US
Practice Address - Phone:661-322-8466
Practice Address - Fax:661-322-5902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38980305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA38980Medicaid
CAA38980OtherMEDICARE
CAA38980OtherMEDICARE