Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 10200 | CA |
NPI | 1568803039 |
---|---|
Provider Name | Mrs. Poonam Bajaj |
First Address | Cupertino, CA 95014-6401 |
Second Address | Cupertino, CA 95014-6401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2013 |
Last Update Date | 12/07/2013 |