Provider Demographics
NPI:1831292994
Name:GHUMMAN, AMRITA (MD)
Entity Type:Individual
Prefix:DR
First Name:AMRITA
Middle Name:
Last Name:GHUMMAN
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 1:1595 SOQUEL DR
Mailing Address - Street 2:STE 330
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1719
Mailing Address - Country:US
Mailing Address - Phone:831-465-7761
Mailing Address - Fax:831-475-1156
Practice Address - Street 1:13350 BIG BASIN WAY
Practice Address - Street 2:
Practice Address - City:BOULDER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95006-9237
Practice Address - Country:US
Practice Address - Phone:831-338-6491
Practice Address - Fax:831-338-2767
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89319207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0028553OtherMEDI-CAL ID NUMBER
CAZZZ20178ZMedicare ID - Type UnspecifiedMEDICARE ID NUMBER
CA141969Medicare UPIN