Healthcare Provider Details

I. General information

NPI: 1629268073
Provider Name (Legal Business Name): MINAL MEHTA MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18111 BROOKHURST ST #4450
FOUNTAIN VALLEY CA
92708
US

IV. Provider business mailing address

18111 BROOKHURST ST #4450
FOUNTAIN VALLEY CA
92708
US

V. Phone/Fax

Practice location:
  • Phone: 714-848-2383
  • Fax: 714-848-4083
Mailing address:
  • Phone: 714-848-2383
  • Fax: 714-848-4083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA79701
License Number StateCA

VIII. Authorized Official

Name: MR. MINAL GUNVANTRAY MEHTA
Title or Position: PRESIDENT
Credential: MD
Phone: 714-848-2383