Healthcare Provider Details

I. General information

NPI: 1467982256
Provider Name (Legal Business Name): KAMAL AHMED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5533 RED JASPER WAY
ANTELOPE CA
95843-3710
US

IV. Provider business mailing address

5533 RED JASPER WAY
ANTELOPE CA
95843-3710
US

V. Phone/Fax

Practice location:
  • Phone: 408-345-5293
  • Fax:
Mailing address:
  • Phone: 408-345-5293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number112428
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: