Provider Demographics
NPI:1669811733
Name:AFZAL, KOMAL (DO)
Entity type:Individual
Prefix:MRS
First Name:KOMAL
Middle Name:
Last Name:AFZAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KOMAL
Other - Middle Name:
Other - Last Name:AHUJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:QUALITY DEPARTMENT
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1820 41ST AVE
Practice Address - Street 2:SUITE D
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2516
Practice Address - Country:US
Practice Address - Phone:831-476-3000
Practice Address - Fax:831-476-9009
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315060927208000000X
CA20A14853208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics