Healthcare Provider Details

I. General information

NPI: 1669811733
Provider Name (Legal Business Name): KOMAL AFZAL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KOMAL AHUJA

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 41ST AVE SUITE D
CAPITOLA CA
95010-2516
US

IV. Provider business mailing address

3400 DATA DR QUALITY DEPARTMENT
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 831-476-3000
  • Fax: 831-476-9009
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5315060927
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A14853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: