Healthcare Provider Details

I. General information

NPI: 1235612078
Provider Name (Legal Business Name): AJOOMA JOY CHEERAMKUZHIYIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1149 E JULIAN ST BLDG H
SAN JOSE CA
95116-1005
US

IV. Provider business mailing address

6840 VIA DEL ORO STE 210
SAN JOSE CA
95119-1372
US

V. Phone/Fax

Practice location:
  • Phone: 408-535-6001
  • Fax: 408-535-2348
Mailing address:
  • Phone: 408-284-2280
  • Fax: 408-754-0450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95009605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: