Basic Information
Provider Information | |||||||||
NPI: | 1851373534 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MEHTON | ||||||||
FirstName: | NIRMAL | ||||||||
MiddleName: | SINGH | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 496084 | ||||||||
Address2: |   | ||||||||
City: | REDDING | ||||||||
State: | CA | ||||||||
PostalCode: | 960496084 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5302410473 | ||||||||
FaxNumber: | 5302415377 | ||||||||
Practice Location | |||||||||
Address1: | 2830 EAST ST | ||||||||
Address2: |   | ||||||||
City: | ANDERSON | ||||||||
State: | CA | ||||||||
PostalCode: | 960073408 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5303652545 | ||||||||
FaxNumber: | 5303657349 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/17/2005 | ||||||||
LastUpdateDate: | 02/13/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A54327 | CA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | GR0092270 | 05 | CA |   | MEDICAID | RHM53832H | 05 | CA |   | MEDICAID | BCP53832H | 05 | CA |   | MEDICAID |