Healthcare Provider Details

I. General information

NPI: 1497869770
Provider Name (Legal Business Name): MINI MEHRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 TERMINO AVE STE 300
LONG BEACH CA
90804-2157
US

IV. Provider business mailing address

3640 LOMITA BLVD STE 102
TORRANCE CA
90505-3984
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-3009
  • Fax: 562-933-8557
Mailing address:
  • Phone: 562-933-6730
  • Fax: 562-933-6744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberA60591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: