Healthcare Provider Details

I. General information

NPI: 1194253872
Provider Name (Legal Business Name): VIVEK MITTAL, M.D. AND MANISHA MITTAL, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 E FIR AVE STE 104
FRESNO CA
93720-0398
US

IV. Provider business mailing address

7045 N MAPLE AVE STE 101
FRESNO CA
93720-8008
US

V. Phone/Fax

Practice location:
  • Phone: 559-900-4013
  • Fax: 559-900-4172
Mailing address:
  • Phone: 559-900-4013
  • Fax: 559-900-4172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA125783
License Number StateCA

VIII. Authorized Official

Name: VIVEK MITTAL
Title or Position: PRESIDENT
Credential: MD
Phone: 559-900-4013