Provider Demographics
NPI:1912294836
Name:KAJLA, AMRIT (NP)
Entity Type:Individual
Prefix:
First Name:AMRIT
Middle Name:
Last Name:KAJLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 WRIGHT ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4041
Mailing Address - Country:US
Mailing Address - Phone:916-482-4856
Mailing Address - Fax:
Practice Address - Street 1:1750 WRIGHT ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4041
Practice Address - Country:US
Practice Address - Phone:916-482-4856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 15748363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1730237116Medicaid
CA1649457474Medicaid
CA1275710006Medicaid
CA1548447378Medicaid