Healthcare Provider Details

I. General information

NPI: 1295334035
Provider Name (Legal Business Name): NIKITHA MEHTA M.SC., RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1063 MCGAW AVE
IRVINE CA
92614-5505
US

IV. Provider business mailing address

605 MONTE VIS
IRVINE CA
92602-2012
US

V. Phone/Fax

Practice location:
  • Phone: 714-230-9393
  • Fax:
Mailing address:
  • Phone: 310-980-7610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: