Provider Demographics
NPI:1104895739
Name:MEHTA, VIRAL (MD)
Entity type:Individual
Prefix:DR
First Name:VIRAL
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5945 TRUXTUN AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0610
Mailing Address - Country:US
Mailing Address - Phone:661-631-5544
Mailing Address - Fax:661-631-5546
Practice Address - Street 1:5945 TRUXTUN AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0610
Practice Address - Country:US
Practice Address - Phone:661-631-5544
Practice Address - Fax:661-631-5546
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47851207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A478510OtherBLUE SHIELD
060051588OtherMEDICARE RAILROAD
CA00A478511Medicaid
CA00A478511Medicaid
CA00A478511Medicaid