Provider Demographics
NPI:1366752701
Name:AMAL K GUHA MD INC
Entity type:Organization
Organization Name:AMAL K GUHA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AMAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-242-2099
Mailing Address - Street 1:16124 KASOTA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2232
Mailing Address - Country:US
Mailing Address - Phone:760-242-2099
Mailing Address - Fax:760-242-5065
Practice Address - Street 1:16124 KASOTA RD
Practice Address - Street 2:SUITE A
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2232
Practice Address - Country:US
Practice Address - Phone:760-242-2099
Practice Address - Fax:760-242-5065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35044207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty