Healthcare Provider Details

I. General information

NPI: 1558551143
Provider Name (Legal Business Name): ABHILASHA JAMWAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ALHAMBRA AVE
MARTINEZ CA
94553-3156
US

IV. Provider business mailing address

2500 ALHAMBRA AVE
MARTINEZ CA
94553-3156
US

V. Phone/Fax

Practice location:
  • Phone: 925-370-5000
  • Fax: 925-370-5275
Mailing address:
  • Phone: 925-370-5000
  • Fax: 925-370-5275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36117607
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: