Healthcare Provider Details

I. General information

NPI: 1437484904
Provider Name (Legal Business Name): SARJAK MEHTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2009
Last Update Date: 12/08/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 LONG BEACH BLVD LONG BEACH ADULT MHS
LONG BEACH CA
90806-5501
US

IV. Provider business mailing address

1975 LONG BEACH BLVD LONG BEACH ADULT MHS
LONG BEACH CA
90806-5501
US

V. Phone/Fax

Practice location:
  • Phone: 562-599-9280
  • Fax:
Mailing address:
  • Phone: 562-599-9280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA125433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: