Healthcare Provider Details

I. General information

NPI: 1023622669
Provider Name (Legal Business Name): AVANTI HEALTH PROVIDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 N ALTA AVE STE B
DINUBA CA
93618-3250
US

IV. Provider business mailing address

531 N ALTA AVE STE B
DINUBA CA
93618-3250
US

V. Phone/Fax

Practice location:
  • Phone: 559-568-3151
  • Fax: 800-507-1641
Mailing address:
  • Phone: 559-568-3151
  • Fax: 800-507-1641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MANISH MEHTA
Title or Position: PRESIDENT
Credential: MD
Phone: 559-568-3151