Healthcare Provider Details

I. General information

NPI: 1912320250
Provider Name (Legal Business Name): AMBICA GARG, MD, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N TUSTIN AVE STE 111
SANTA ANA CA
92705-6501
US

IV. Provider business mailing address

999 N TUSTIN AVE STE 111
SANTA ANA CA
92705-6501
US

V. Phone/Fax

Practice location:
  • Phone: 714-953-1112
  • Fax: 714-547-5792
Mailing address:
  • Phone: 714-953-1112
  • Fax: 714-547-5792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberA117019
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMBICA GARG
Title or Position: OWNER
Credential: M.D.
Phone: 714-558-7277