Healthcare Provider Details

I. General information

NPI: 1467907949
Provider Name (Legal Business Name): BHARAT MEHTA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8469 ENTREKEN WAY
SAN DIEGO CA
92129-4460
US

IV. Provider business mailing address

8469 ENTREKEN WAY
SAN DIEGO CA
92129-4460
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-5933
  • Fax: 619-543-6784
Mailing address:
  • Phone: 619-543-5933
  • Fax: 619-543-6784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number41225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: