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General NPI Number Information
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NPI Number | 1134008824
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Entity Type | Organization
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Legal Business Name | HAVEN OBGYN PC
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Dates
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Enumeration Date | 08/28/2025
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 1600 CREEKSIDE DR STE 3100
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City | FOLSOM
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State | CA
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Zip | 95630-3486
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Country | US
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Telephone | 916-269-8865
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Fax | 916-265-9659
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Provider Business Mailing Address
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Address Line | 6091 EDGEHILL DR
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-5475
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Country | US
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Telephone | 916-269-8865
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Fax | 916-265-9659
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Authorized Official
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Title or Position | MD OWNER
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Name | NIKITA MISHRA
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Credential | MD
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Telephone | 916-269-8865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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