Provider Demographics
NPI:1063852168
Name:MEHTA, DUTT (DO)
Entity type:Individual
Prefix:
First Name:DUTT
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43112 15TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-6219
Mailing Address - Country:US
Mailing Address - Phone:661-723-2636
Mailing Address - Fax:661-726-2409
Practice Address - Street 1:43112 15TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-6219
Practice Address - Country:US
Practice Address - Phone:661-723-2636
Practice Address - Fax:661-726-2409
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020768207Q00000X
CA14678207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine