Provider Demographics
NPI:1194907584
Name:MITTAL, VIKRANT (MBBS, MD, MHS)
Entity type:Individual
Prefix:DR
First Name:VIKRANT
Middle Name:
Last Name:MITTAL
Suffix:
Gender:M
Credentials:MBBS, MD, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 OAK RD STE 270
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2078
Mailing Address - Country:US
Mailing Address - Phone:925-944-9711
Mailing Address - Fax:
Practice Address - Street 1:3100 OAK RD STE 270
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-2078
Practice Address - Country:US
Practice Address - Phone:925-944-9711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1291172084P0800X
PAMD4432162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
221479Medicare PIN