Healthcare Provider Details

I. General information

NPI: 1730192725
Provider Name (Legal Business Name): PAIN MANAGEMENT & HOLISTIC HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/22/2020
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: 408-528-7246
  • Fax:
Mailing address:
  • Phone: 408-528-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberC51516
License Number StateCA

VIII. Authorized Official

Name: DR. MAHENDRA P MEHTA
Title or Position: OWNER
Credential: MD
Phone: 408-528-7246