Healthcare Provider Details

I. General information

NPI: 1326665886
Provider Name (Legal Business Name): POORVA KULKARNI PT DPT MHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15585 MONTEREY RD STE D
MORGAN HILL CA
95037-5460
US

IV. Provider business mailing address

6705 MAGNETIC LOOP
SAN JOSE CA
95119-1757
US

V. Phone/Fax

Practice location:
  • Phone: 669-377-1133
  • Fax:
Mailing address:
  • Phone: 317-829-4288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number42221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: