Healthcare Provider Details

I. General information

NPI: 1518626662
Provider Name (Legal Business Name): PIRAN MEHTA PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 02/23/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 S LEMON AVE UNIT 9892
WALNUT CA
91789-2706
US

IV. Provider business mailing address

50 PALATINE APT 423
IRVINE CA
92612-5637
US

V. Phone/Fax

Practice location:
  • Phone: 415-651-3458
  • Fax:
Mailing address:
  • Phone: 714-390-4666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2021761
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95019449
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: