Healthcare Provider Details

I. General information

NPI: 1356655641
Provider Name (Legal Business Name): RINA R. MEHTA PHARM.D., BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MOWRY AVE
FREMONT CA
94538-1716
US

IV. Provider business mailing address

46357 PASEO PADRE PKWY
FREMONT CA
94539-6926
US

V. Phone/Fax

Practice location:
  • Phone: 510-791-3495
  • Fax:
Mailing address:
  • Phone: 510-396-5206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number64027
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number3111033
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: