Provider Demographics
NPI:1144483256
Name:MEHTA, CHIRAG PANKAJ (MD)
Entity type:Individual
Prefix:DR
First Name:CHIRAG
Middle Name:PANKAJ
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12760 HESPERIA RD STE C
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8305
Mailing Address - Country:US
Mailing Address - Phone:760-338-0911
Mailing Address - Fax:442-229-2664
Practice Address - Street 1:12760 HESPERIA RD STE C
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8305
Practice Address - Country:US
Practice Address - Phone:760-338-0911
Practice Address - Fax:760-243-0471
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125054295207R00000X
CAA135217207R00000X, 207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology