Healthcare Provider Details

I. General information

NPI: 1477667434
Provider Name (Legal Business Name): HEMAL MEHTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W 39TH AVE
SAN MATEO CA
94403-4364
US

IV. Provider business mailing address

842 HOLLENBECK AVE
SUNNYVALE CA
94087-1873
US

V. Phone/Fax

Practice location:
  • Phone: 650-573-2669
  • Fax:
Mailing address:
  • Phone: 408-245-4806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA64115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: