Healthcare Provider Details

I. General information

NPI: 1255691341
Provider Name (Legal Business Name): ABHISHEK MEHTA MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 N H ST
LOMPOC CA
93436
US

IV. Provider business mailing address

PO BOX 62106
SANTA BARBARA CA
93160-2106
US

V. Phone/Fax

Practice location:
  • Phone: 805-737-8760
  • Fax: 805-681-1768
Mailing address:
  • Phone: 805-737-8760
  • Fax: 805-681-1768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA147857
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierA147857
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerSTATE LICENSE NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: