Healthcare Provider Details

I. General information

NPI: 1477583912
Provider Name (Legal Business Name): SNEH L. MEHTANI DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3722 TIBBETTS ST
RIVERSIDE CA
92506-2605
US

IV. Provider business mailing address

PO BOX 655
CORONA CA
92878-0655
US

V. Phone/Fax

Practice location:
  • Phone: 951-642-1059
  • Fax: 951-848-9695
Mailing address:
  • Phone: 951-642-1059
  • Fax: 951-848-9695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4477
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: