Basic Information
| Provider Information | |||||||||
| NPI: | 1831292994 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GHUMMAN | ||||||||
| FirstName: | AMRITA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1595 SOQUEL DR | ||||||||
| Address2: | STE 330 | ||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950651719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314657761 | ||||||||
| FaxNumber: | 8314751156 | ||||||||
| Practice Location | |||||||||
| Address1: | 13350 BIG BASIN WAY | ||||||||
| Address2: | |||||||||
| City: | BOULDER CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950069237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8313386491 | ||||||||
| FaxNumber: | 8313382767 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A89319 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | GR0028553 | 01 | CA | MEDI-CAL ID NUMBER | OTHER |