1720697709 NPI number — AMEET K. GREWAL MD, INC

Table of content: (NPI 1720697709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720697709 NPI number — AMEET K. GREWAL MD, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMEET K. GREWAL MD, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MONTEREY EAR, NOSE & THROAT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720697709
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 MONTSALAS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTEREY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93940-5285
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-896-9539
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
880 CASS ST STE 209
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTEREY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93940-2909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-204-0282
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2020

Additional Information

Authorized Official

Authorized Official Last Name:
GREWAL
Authorized Official First Name:
AMEET
Authorized Official Middle Name:
KAUR
Authorized Official Title or Position:
SURGEON
Authorized Official Telephone Number:
510-896-9539

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1003130634 . This is a "PERSONAL NPI NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: GR0066350 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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