Provider Demographics
NPI:1225460306
Name:ALGOTAR, AMIT MOHAN (PHD, MPH, MBBS)
Entity type:Individual
Prefix:DR
First Name:AMIT
Middle Name:MOHAN
Last Name:ALGOTAR
Suffix:
Gender:M
Credentials:PHD, MPH, MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 E WARNER RD UNIT 121
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3220
Mailing Address - Country:US
Mailing Address - Phone:520-481-5787
Mailing Address - Fax:
Practice Address - Street 1:24785 STEWART ST STE 204
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2751
Practice Address - Country:US
Practice Address - Phone:909-558-4918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR73829390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program