Healthcare Provider Details

I. General information

NPI: 1346328499
Provider Name (Legal Business Name): AMAL KUMAR GUHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16124 KASOTA RD STE A & B
APPLE VALLEY CA
92307-2216
US

IV. Provider business mailing address

16124 KASOTA RD STE A & B
APPLE VALLEY CA
92307-2216
US

V. Phone/Fax

Practice location:
  • Phone: 760-242-2099
  • Fax: 760-242-5065
Mailing address:
  • Phone: 760-242-2099
  • Fax: 760-242-5065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA35044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: