Healthcare Provider Details

I. General information

NPI: 1578998589
Provider Name (Legal Business Name): ELIKA KAMDAR PA-C, MMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 CREEK RD
IRVINE CA
92604-4724
US

IV. Provider business mailing address

11525 BROOKSHIRE AVE STE 101
DOWNEY CA
90241-4982
US

V. Phone/Fax

Practice location:
  • Phone: 949-297-3838
  • Fax:
Mailing address:
  • Phone: 949-297-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA23201
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: