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General NPI Number Information
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NPI Number | 1215916200
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Entity Type | Individual
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Provider Name | POOJA C MITTAL DO
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Gender | Female
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 09/11/2008
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Provider Practice Location Address
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Address Line | 955 POTRERO AVE BUILDING 80 WARD 83
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City | SAN FRANCISCO
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State | CA
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Zip | 94110
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Country | US
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Telephone | 415-443-6810
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Fax | 415-443-8387
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Provider Business Mailing Address
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Address Line | 955 POTRERO AVENUE BUILDING 80 WARD 83
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City | SAN FRANCISCO
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State | CA
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Zip | 94110
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Country | US
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Telephone | 415-443-6810
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Fax | 415-443-8387
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 225413
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A8712
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License Number State | CA
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