Basic Information
| Provider Information | |||||||||
| NPI: | 1750517231 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAMOONA | ||||||||
| FirstName: | AMRITH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 COFFEE RD | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953554201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095216097 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1401 SPANOS CT | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953552810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095241211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2009 | ||||||||
| LastUpdateDate: | 01/19/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 01066833A | IN | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 25MA08993500 | NJ | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | MD444108 | PA | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | A134229 | CA | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0275662 | 05 | NJ | MEDICAID | 200945550 | 05 | IN | MEDICAID | 102647807 | 05 | PA | MEDICAID |