Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 51062 | CA |
NPI | 1013580232 |
---|---|
Provider Name | Diksha Venkatesh |
First Address | Cupertino, CA 95014-3304 |
Second Address | Burlingame, CA 94010-3207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2021 |
Last Update Date | 24/07/2021 |