Healthcare Provider Details

I. General information

NPI: 1245602796
Provider Name (Legal Business Name): MEHTA ORTHO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 10/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 TORRANCE BLVD 310
TORRANCE CA
90503-4504
US

IV. Provider business mailing address

4201 TORRANCE BLVD 310
TORRANCE CA
90503-4504
US

V. Phone/Fax

Practice location:
  • Phone: 310-644-1151
  • Fax: 310-644-3115
Mailing address:
  • Phone: 310-644-1151
  • Fax: 310-644-3115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. AKSHAY MANISH MEHTA
Title or Position: OWNER
Credential: MD
Phone: 310-699-6886