Provider Demographics
NPI:1689856635
Name:DHARAWAT, AMITA (MD)
Entity Type:Individual
Prefix:DR
First Name:AMITA
Middle Name:
Last Name:DHARAWAT
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 1:900 S FIGUEROA ST
Mailing Address - Street 2:APT #804
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-1698
Mailing Address - Country:US
Mailing Address - Phone:310-854-4995
Mailing Address - Fax:
Practice Address - Street 1:845 N 10TH ST STE 3
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-1348
Practice Address - Country:US
Practice Address - Phone:805-525-0215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-02
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA121022207RC0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program