Healthcare Provider Details

I. General information

NPI: 1710937875
Provider Name (Legal Business Name): MAHENDRA P MEHTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 THE VILLAGES PKWY
SAN JOSE CA
95135-1442
US

IV. Provider business mailing address

5911 KILLARNEY CIR
SAN JOSE CA
95138-2349
US

V. Phone/Fax

Practice location:
  • Phone: 408-274-2244
  • Fax: 408-528-7246
Mailing address:
  • Phone: 408-528-7246
  • Fax: 408-528-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC51516
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: