1831164029 NPI number — PARAG MEHTA MD

Table of content: PARAG MEHTA MD (NPI 1831164029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831164029 NPI number — PARAG MEHTA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEHTA
Provider First Name:
PARAG
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831164029
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1294 W 6TH STREET
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
SAN PEDRO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90731-2997
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-521-5990
Provider Business Mailing Address Fax Number:
310-521-5991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1294 W 6TH STREET
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
SAN PEDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90731-2997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-521-5990
Provider Business Practice Location Address Fax Number:
310-521-5991
Provider Enumeration Date:
02/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  A50838 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 130025763 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 318256 . This is a "UIN (MEDICARE)" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 126390000 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00A508380 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4515740001 . This is a "NORIDIAN/DME PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1831164029 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5422000A508380 . This is a "B SHIELD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com