Individual
DR. KETAN C MEHTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3867 MONTGOMERY DR, SANTA ROSA, CA 95405-5244
(707) 525-3780
(707) 525-3783
Mailing address
3867 MONTGOMERY DR, SANTA ROSA, CA 95405-5244
(707) 525-3780
(707) 525-3783
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A41306
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A413060
—
CA
Enumeration date
03/07/2007
Last updated
01/13/2011
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