Healthcare Provider Details

I. General information

NPI: 1740607902
Provider Name (Legal Business Name): ANITA MEHTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-1249 MEHEULA PKWY
MILILANI HI
96789-1779
US

IV. Provider business mailing address

95-1022 HOAKUA ST
MILILANI HI
96789-5590
US

V. Phone/Fax

Practice location:
  • Phone: 808-625-6444
  • Fax:
Mailing address:
  • Phone: 808-772-7476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246R00000X
TaxonomyPathology Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: