Healthcare Provider Details

I. General information

NPI: 1679657043
Provider Name (Legal Business Name): NIDHI MEHROTRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6769 N WILLOW AVE SUITE 101
FRESNO CA
93710-5900
US

IV. Provider business mailing address

6769 N WILLOW AVE SUITE 101
FRESNO CA
93710-5900
US

V. Phone/Fax

Practice location:
  • Phone: 559-325-2400
  • Fax: 888-611-8817
Mailing address:
  • Phone: 559-325-2400
  • Fax: 888-611-8817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA72677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: