Healthcare Provider Details

I. General information

NPI: 1134294473
Provider Name (Legal Business Name): ATA O. MEHRTASH M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1491 E LA PALMA AVE SUITE A
ANAHEIM CA
92805-1564
US

IV. Provider business mailing address

1491 E LA PALMA AVE SUITE A
ANAHEIM CA
92805-1564
US

V. Phone/Fax

Practice location:
  • Phone: 714-776-2390
  • Fax: 714-776-3287
Mailing address:
  • Phone: 714-776-2390
  • Fax: 714-776-3287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC38016
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberC38016
License Number StateCA

VIII. Authorized Official

Name: DR. ATA O. MEHRTASH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-776-2390