Provider Demographics
NPI:1518999325
Name:KATTAPURAM, AMY (M D)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KATTAPURAM
Suffix:
Gender:F
Credentials:M D
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:150 N ROBERTSON BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2142
Mailing Address - Country:US
Mailing Address - Phone:310-657-8585
Mailing Address - Fax:310-657-8484
Practice Address - Street 1:1030 S GLENDALE AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-5612
Practice Address - Country:US
Practice Address - Phone:818-241-4162
Practice Address - Fax:818-243-3368
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2009-05-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA084506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA084506OtherLICENSE NUMBER