Provider Demographics
NPI:1730380718
Name:KHATIBI, MEHRI (MD)
Entity type:Individual
Prefix:DR
First Name:MEHRI
Middle Name:
Last Name:KHATIBI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4447
Mailing Address - Country:US
Mailing Address - Phone:209-577-5005
Mailing Address - Fax:209-521-1533
Practice Address - Street 1:200 W COOLIDGE AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4447
Practice Address - Country:US
Practice Address - Phone:209-577-5005
Practice Address - Fax:209-521-1533
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 113691207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology