Healthcare Provider Details

I. General information

NPI: 1346204104
Provider Name (Legal Business Name): UDAYA RAMADAS KAMATH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18564 US HIGHWAY 18 SUITE 103 & 104
APPLE VALLEY CA
92307-2312
US

IV. Provider business mailing address

19809 SENECA RD
APPLE VALLEY CA
92307-5519
US

V. Phone/Fax

Practice location:
  • Phone: 760-946-4840
  • Fax:
Mailing address:
  • Phone: 760-946-4840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA50460
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00A504600
Identifier TypeMEDICAID
Identifier StateCA
Identifier Issuer
# 2
IdentifierF80832
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerUPIN
# 3
IdentifierZZZ61434Z
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerBLUE CROSS/SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: