Healthcare Provider Details

I. General information

NPI: 1356202808
Provider Name (Legal Business Name): HAVEN PSYCHIATRY, A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2025
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 DOUGLAS BLVD STE 300
ROSEVILLE CA
95661-3302
US

IV. Provider business mailing address

2510 DOUGLAS BLVD STE 300
ROSEVILLE CA
95661-3302
US

V. Phone/Fax

Practice location:
  • Phone: 279-600-4411
  • Fax: 279-600-4408
Mailing address:
  • Phone: 279-600-4411
  • Fax: 279-600-4408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MONEESHINDRA MITTAL
Title or Position: PRESIDENT
Credential: MD
Phone: 279-600-4411