Healthcare Provider Details

I. General information

NPI: 1164340949
Provider Name (Legal Business Name): CHOLADA JITMART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2044 FILLMORE ST
SAN FRANCISCO CA
94115-2777
US

IV. Provider business mailing address

795 33RD AVE
SAN FRANCISCO CA
94121-3427
US

V. Phone/Fax

Practice location:
  • Phone: 415-888-8368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: