Healthcare Provider Details

I. General information

NPI: 1366050346
Provider Name (Legal Business Name): MANSI VERMA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 11/14/2024
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MOORPARK AVE SUITE 300
SAN JOSE CA
95128
US

IV. Provider business mailing address

1063 MORSE AVE APT 21-201
SUNNYVALE CA
94089
US

V. Phone/Fax

Practice location:
  • Phone: 408-975-2730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSB94025417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: