Healthcare Provider Details

I. General information

NPI: 1346440500
Provider Name (Legal Business Name): AHMED MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15201 11TH ST STE 400
VICTORVILLE CA
92395-3735
US

IV. Provider business mailing address

15201 11TH ST STE 400
VICTORVILLE CA
92395-3735
US

V. Phone/Fax

Practice location:
  • Phone: 760-955-7095
  • Fax: 760-951-1076
Mailing address:
  • Phone: 760-955-7095
  • Fax: 760-951-1076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA51407
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA51617
License Number StateCA

VIII. Authorized Official

Name: KELLY AHMED
Title or Position: OWNER
Credential: MD
Phone: 760-956-1095