Provider Demographics
NPI:1861837221
Name:AMATYA, SUBHA LAXMI (MD)
Entity Type:Individual
Prefix:
First Name:SUBHA
Middle Name:LAXMI
Last Name:AMATYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9122 ADAMS AVENUE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646
Mailing Address - Country:US
Mailing Address - Phone:714-378-0900
Mailing Address - Fax:714-378-5166
Practice Address - Street 1:9122 ADAMS AVENUE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646
Practice Address - Country:US
Practice Address - Phone:714-378-0900
Practice Address - Fax:714-378-5166
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA150777208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics