Healthcare Provider Details

I. General information

NPI: 1669885885
Provider Name (Legal Business Name): DAVID AHAMBA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S G ST
SAN BERNARDINO CA
92410
US

IV. Provider business mailing address

1200 CALIFORNIA ST STE 240
REDLANDS CA
92374-2948
US

V. Phone/Fax

Practice location:
  • Phone: 909-382-7100
  • Fax:
Mailing address:
  • Phone: 909-558-6526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT207310
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA149859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: