Provider Demographics
NPI:1881688422
Name:AJIT, AMIRTHA (MD)
Entity Type:Individual
Prefix:
First Name:AMIRTHA
Middle Name:
Last Name:AJIT
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 1:1751 W ROMNEYA DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1815
Mailing Address - Country:US
Mailing Address - Phone:714-776-3180
Mailing Address - Fax:714-991-1932
Practice Address - Street 1:1751 W ROMNEYA DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1815
Practice Address - Country:US
Practice Address - Phone:714-776-3180
Practice Address - Fax:714-991-1932
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56179207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A561790Medicaid
G96961Medicare UPIN
CAWA56179AMedicare ID - Type Unspecified