Healthcare Provider Details

I. General information

NPI: 1144472754
Provider Name (Legal Business Name): VISHAAL MEHRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 02/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 WASHINGTON ST SUITE 200
SAN DIEGO CA
92103-2209
US

IV. Provider business mailing address

770 WASHINGTON ST SUITE 200
SAN DIEGO CA
92103-2209
US

V. Phone/Fax

Practice location:
  • Phone: 858-278-3647
  • Fax: 858-278-3660
Mailing address:
  • Phone: 858-278-3647
  • Fax: 858-278-3660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA81407
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: