Healthcare Provider Details

I. General information

NPI: 1255881546
Provider Name (Legal Business Name): NATALIE ACHAMALLAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD RM 6729
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

400 W PUEBLO ST SBCH MEDICAL EDUCATION
SANTA BARBARA CA
93105-4353
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-1838
  • Fax:
Mailing address:
  • Phone: 805-569-7315
  • Fax: 805-569-8358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA158572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: