MEDICARE: PAIN MANAGEMENT & HOLISTIC HEALTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	C51516	CA

General Provider Information

NPI Number	:	1730192725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN MANAGEMENT & HOLISTIC HEALTH CENTER

Provider Business Mailing Address
First Line	:	5911 KILLARNEY CIR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95138-2349
Country	:	US
Telephone Number	:	408-528-7246
Fax Number	:

Provider Business Practice Location Address
First Line	:	2919 THE VILLAGES PKWY
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95135-1442
Country	:	US
Telephone Number	:	408-528-7246
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MAHENDRA P MEHTA
Credential	:	MD
Telephone Number	:	408-528-7246

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	08/22/2020

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