=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750915260
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMRUTA SAMARTH MD, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2020
-----------------------------------------------------
Last Update Date | 03/01/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15891 LOS GATOS ALMADEN RD
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-3742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-378-4871
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 208 CALLE MARGUERITA
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-1244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-378-4871
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. AMRUTA SAMARTH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 949-378-4871
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------