Healthcare Provider Details

I. General information

NPI: 1013417294
Provider Name (Legal Business Name): NADER MEHRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 FERMI PL STE 106
DAVIS CA
95618-9411
US

IV. Provider business mailing address

2152 DANBERRY LN
SAN RAFAEL CA
94903-1258
US

V. Phone/Fax

Practice location:
  • Phone: 530-750-1955
  • Fax:
Mailing address:
  • Phone: 415-497-2067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number104292
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: