Healthcare Provider Details

I. General information

NPI: 1518903822
Provider Name (Legal Business Name): JOY RUZBEH MEHTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2623 E SLAUSON AVE
HUNTINGTON PARK CA
90255-2926
US

IV. Provider business mailing address

PO BOX 451605
LOS ANGELES CA
90045-8519
US

V. Phone/Fax

Practice location:
  • Phone: 323-581-0568
  • Fax:
Mailing address:
  • Phone: 310-645-8352
  • Fax: 310-410-0008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA34591
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA34591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: