Healthcare Provider Details

I. General information

NPI: 1366461022
Provider Name (Legal Business Name): POMPA CHATTERJEE MALAKAR R.N. C.N.S. PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39199 LIBERTY ST
FREMONT CA
94538-1501
US

IV. Provider business mailing address

35625 GLEASON LN
FREMONT CA
94536-2522
US

V. Phone/Fax

Practice location:
  • Phone: 650-493-5000
  • Fax:
Mailing address:
  • Phone: 650-493-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR.N.479436
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95010872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: