Healthcare Provider Details

I. General information

NPI: 1740575455
Provider Name (Legal Business Name): DEEPTI K MEHTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SERENO DR
VALLEJO CA
94589-2441
US

IV. Provider business mailing address

688 N RIMSDALE AVE APT 30
COVINA CA
91722-3544
US

V. Phone/Fax

Practice location:
  • Phone: 707-651-3392
  • Fax:
Mailing address:
  • Phone: 517-214-3465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA117235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: