Provider Demographics
NPI:1861951030
Name:KAMAL KOTAK
Entity type:Organization
Organization Name:KAMAL KOTAK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-270-0800
Mailing Address - Street 1:10531 4S COMMONS DR STE 425
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3517
Mailing Address - Country:US
Mailing Address - Phone:858-951-6550
Mailing Address - Fax:
Practice Address - Street 1:230 AVOCADO AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4604
Practice Address - Country:US
Practice Address - Phone:858-270-0800
Practice Address - Fax:858-227-4131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2019-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty