Healthcare Provider Details

I. General information

NPI: 1861951030
Provider Name (Legal Business Name): KAMAL KOTAK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 05/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 AVOCADO AVE
EL CAJON CA
92020-4604
US

IV. Provider business mailing address

10531 4S COMMONS DR STE 425
SAN DIEGO CA
92127-3517
US

V. Phone/Fax

Practice location:
  • Phone: 858-270-0800
  • Fax: 858-227-4131
Mailing address:
  • Phone: 858-951-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAMAL KOTAK
Title or Position: DIRECTOR
Credential: MD
Phone: 858-270-0800