Provider Demographics
NPI:1003130634
Name:GREWAL PITTA, AMEET KAUR (MD)
Entity Type:Individual
Prefix:DR
First Name:AMEET
Middle Name:KAUR
Last Name:GREWAL PITTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:26 MONTSALAS DR
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5285
Mailing Address - Country:US
Mailing Address - Phone:831-204-0282
Mailing Address - Fax:508-923-9894
Practice Address - Street 1:880 CASS ST STE 209
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2909
Practice Address - Country:US
Practice Address - Phone:831-204-0282
Practice Address - Fax:508-923-9894
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA135173207Y00000X
NY28400-1207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0066350Medicaid
1720697709OtherNPI TYPE 2