=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922070937
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MANISHA OJHA MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2006
-----------------------------------------------------
Last Update Date | 12/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 MCALLISTER ST STUDENT HEALTH DEPARTMENT, SECOND FLOOR
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94102-4707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-565-4612
-----------------------------------------------------
Fax | 415-565-4607
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 850 SAGE DR
-----------------------------------------------------
City | MARTINEZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94553-5956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | A78089
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | A78089
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------