Healthcare Provider Details

I. General information

NPI: 1275790941
Provider Name (Legal Business Name): POOJA AMAR NAWATHE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: POOJA D KULKARNI M.D.

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 WELCH RD
PALO ALTO CA
94304
US

IV. Provider business mailing address

725 WELCH RD
PALO ALTO CA
94304-1601
US

V. Phone/Fax

Practice location:
  • Phone: 650-497-8000
  • Fax:
Mailing address:
  • Phone: 650-497-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA125840
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number267532
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA125840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: