Basic Information
| Provider Information | |||||||||
| NPI: | 1053976878 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEHTA | ||||||||
| FirstName: | TRUSHA | ||||||||
| MiddleName: | AMIT | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 620 SHADOW LN | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023888000 | ||||||||
| FaxNumber: | 7023888431 | ||||||||
| Practice Location | |||||||||
| Address1: | 620 SHADOW LN | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023888000 | ||||||||
| FaxNumber: | 7023888431 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2019 | ||||||||
| LastUpdateDate: | 05/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | SL1435 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.