Healthcare Provider Details

I. General information

NPI: 1518784925
Provider Name (Legal Business Name): JITIN SHARMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41717 PALM AVE
FREMONT CA
94539-4722
US

IV. Provider business mailing address

41717 PALM AVE
FREMONT CA
94539-4722
US

V. Phone/Fax

Practice location:
  • Phone: 510-657-3600
  • Fax:
Mailing address:
  • Phone: 510-657-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number240099654
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: