Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 5101020768 | MI |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 14678 | CA |
NPI | 1063852168 |
---|---|
Provider Name | Dutt Mehta |
First Address | Lancaster, CA 93534-6219 |
Second Address | Lancaster, CA 93534-6219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2013 |
Last Update Date | 06/12/2021 |