Provider Demographics
NPI:1629019286
Name:MAMTORA, NILIMA H (MD)
Entity Type:Individual
Prefix:DR
First Name:NILIMA
Middle Name:H
Last Name:MAMTORA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 S HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-4525
Mailing Address - Country:US
Mailing Address - Phone:714-956-3535
Mailing Address - Fax:714-956-3078
Practice Address - Street 1:531 S HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-4525
Practice Address - Country:US
Practice Address - Phone:714-956-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A505820207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA203BX0001XOtherSPEC CODE
CAG49066Medicare UPIN
CAA505820Medicare ID - Type Unspecified