Healthcare Provider Details

I. General information

NPI: 1467626341
Provider Name (Legal Business Name): NAMITA ATUL AGARWAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ALHAMBRA AVE
MARTINEZ CA
94553-3156
US

IV. Provider business mailing address

227 OLIVIA CT
SAN RAMON CA
94582
US

V. Phone/Fax

Practice location:
  • Phone: 925-370-5110
  • Fax: 925-370-5142
Mailing address:
  • Phone: 925-361-8722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA61479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: