Healthcare Provider Details

I. General information

NPI: 1780609503
Provider Name (Legal Business Name): AKTHER JAHAN KOTHA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8860 CENTER DR #400
LA MESA CA
91942-3068
US

IV. Provider business mailing address

8860 CENTER DR #400
LA MESA CA
91942-3068
US

V. Phone/Fax

Practice location:
  • Phone: 619-229-1995
  • Fax:
Mailing address:
  • Phone: 619-229-1995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA45440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: