Healthcare Provider Details

I. General information

NPI: 1962949503
Provider Name (Legal Business Name): AMY K MEHTA MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 SAN DIMAS ST BUILDING A SUITE 250
BAKERSFIELD CA
93301
US

IV. Provider business mailing address

3838 SAN DIMAS ST BUILDING A SUITE 250
BAKERSFIELD CA
93301
US

V. Phone/Fax

Practice location:
  • Phone: 661-323-5300
  • Fax:
Mailing address:
  • Phone: 661-323-5300
  • Fax: 661-323-5455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUSAN LAUGHLIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 661-323-5300