Provider Demographics
NPI:1053817353
Name:KAMBLE, SEEMA SURESH
Entity Type:Individual
Prefix:
First Name:SEEMA
Middle Name:SURESH
Last Name:KAMBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MONTE VISTA AVE STE 190
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-6600
Mailing Address - Country:US
Mailing Address - Phone:909-865-9977
Mailing Address - Fax:909-469-2119
Practice Address - Street 1:1601 MONTE VISTA AVE STE 190
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-6600
Practice Address - Country:US
Practice Address - Phone:909-865-9977
Practice Address - Fax:909-469-2119
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.030166207Q00000X
CA20A15191207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1053817353Medicaid