Healthcare Provider Details

I. General information

NPI: 1194879056
Provider Name (Legal Business Name): JANAK K. MEHTANI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2951 FULTON AVE
SACRAMENTO CA
95821-4909
US

IV. Provider business mailing address

2951 FULTON AVE
SACRAMENTO CA
95821-4909
US

V. Phone/Fax

Practice location:
  • Phone: 916-486-7555
  • Fax: 916-486-7557
Mailing address:
  • Phone: 916-486-7555
  • Fax: 916-486-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: VICKIE RAZO
Title or Position: OFFICE MANAGER
Credential:
Phone: 916-486-7555