Provider Demographics
NPI:1962665711
Name:GHOSH, INDUSHREE (MD)
Entity Type:Individual
Prefix:
First Name:INDUSHREE
Middle Name:
Last Name:GHOSH
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 1:3875 AVOCADO BLVD
Mailing Address - Street 2:PRIMARY CARE 2ND FLOOR
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-7303
Mailing Address - Country:US
Mailing Address - Phone:619-670-2913
Mailing Address - Fax:
Practice Address - Street 1:3875 AVOCADO BLVD
Practice Address - Street 2:PRIMARY CARE 2ND FLOOR
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-7303
Practice Address - Country:US
Practice Address - Phone:619-670-2913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA114935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine