Provider Demographics
NPI:1265700975
Name:GARG, AMBICA (M D)
Entity type:Individual
Prefix:
First Name:AMBICA
Middle Name:
Last Name:GARG
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:AMBICA
Other - Middle Name:
Other - Last Name:PRASAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:999 N TUSTIN AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-6501
Mailing Address - Country:US
Mailing Address - Phone:714-953-1112
Mailing Address - Fax:714-547-5792
Practice Address - Street 1:999 N TUSTIN AVE STE 111
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6501
Practice Address - Country:US
Practice Address - Phone:714-953-1112
Practice Address - Fax:714-547-5792
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117019207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology