Provider Demographics
NPI:1013590249
Name:KONCHWALLA, AFEEFA ASHFAQ (MD)
Entity type:Individual
Prefix:
First Name:AFEEFA
Middle Name:ASHFAQ
Last Name:KONCHWALLA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 W FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3817
Mailing Address - Country:US
Mailing Address - Phone:951-929-1333
Mailing Address - Fax:
Practice Address - Street 1:1515 W FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3817
Practice Address - Country:US
Practice Address - Phone:951-929-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA197121207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine