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General NPI Number Information
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NPI Number | 1447091095
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Entity Type | Individual
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Provider Name | DR. POOJA JITENDRA CHOTHANI
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Gender | Female
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Dates
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Enumeration Date | 06/05/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 14124 CULEBRA RD UNIT 113
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City | SAN ANTONIO
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State | TX
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Zip | 78253-7648
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Country | US
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Telephone | 210-787-1554
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Fax |
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Provider Business Mailing Address
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Address Line | 3010 W LOOP 1604 N APT 6208
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City | SAN ANTONIO
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State | TX
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Zip | 78251-3929
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Country | US
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Telephone | 361-277-1747
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 40475
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License Number State | TX
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