Provider Demographics
NPI:1164956637
Name:JAVED AHMAD A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JAVED AHMAD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JAVED
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-863-0155
Mailing Address - Street 1:PO BOX 14117
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92255-4117
Mailing Address - Country:US
Mailing Address - Phone:760-863-0155
Mailing Address - Fax:
Practice Address - Street 1:81833 DR CARREON BLVD
Practice Address - Street 2:STE 2
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-0602
Practice Address - Country:US
Practice Address - Phone:760-863-0155
Practice Address - Fax:760-863-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55292207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty