Healthcare Provider Details

I. General information

NPI: 1912353525
Provider Name (Legal Business Name): NIDHI MEHROTRA MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 05/12/2016
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:
Mailing address:
  • Phone: 559-325-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUMIT VARMA
Title or Position: ADMINISTRATOR
Credential:
Phone: 559-259-7596