| Pranav R. Mehta, M.d., Inc. | |
|
12047 4th St Yucaipa CA 92399-2735 | |
| (909) 797-5101 | |
| (909) 797-5103 |
| Full Name | Pranav R. Mehta, M.d., Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 12047 4th St, Yucaipa, California |
| Authorized Official Name and Position | Pranav Raghuvir Mehta (PRESIDENT) |
| Authorized Official Contact | 9097975101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pranav R. Mehta, M.d., Inc. 12047 4th St Yucaipa CA 92399-2735 Ph: (909) 797-5101 | Pranav R. Mehta, M.d., Inc. 12047 4th St Yucaipa CA 92399-2735 Ph: (909) 797-5101 |
| NPI Number | 1962681270 |
|---|---|
| Provider Enumeration Date | 11/02/2007 |
| Last Update Date | 05/19/2008 |
| Medicare PECOS PAC ID | 3072698786 |
|---|---|
| Medicare Enrollment ID | O20080305000357 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962681270 | NPI | - | NPPES |
| 00G786980 | Medicaid | CA | |
| 080160338 | Other | CA | RR MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G078698 (California) | Primary |
| Provider Name | Pranav R Mehta |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467527762 PECOS PAC ID: 7719062421 Enrollment ID: I20080305000352 |
| Provider Name | Rebecca Ann Baldwin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538797022 PECOS PAC ID: 8224483813 Enrollment ID: I20231017003466 |
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