Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A97179 | CA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | A97179 | CA |
NPI | 1487872313 |
---|---|
Provider Name | Neelu Mehra |
First Address | Fresno, CA 93721-1431 |
Second Address | Fresno, CA 93701-2124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 14/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A971790 | BLUE SHIELD PPO (01) | CA |