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General NPI Number Information
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NPI Number | 1972849495
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Entity Type | Individual
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Provider Name | SMITA PANKAJ AJMERA RPT
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Gender | Female
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Dates
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Enumeration Date | 01/02/2013
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Last Update Date | 01/02/2013
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Provider Practice Location Address
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Address Line | 3550 MOWRY AVE SUITE 101
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City | FREMONT
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State | CA
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Zip | 94538-1460
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Country | US
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Telephone | 510-676-4087
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Fax | 510-745-0192
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Provider Business Mailing Address
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Address Line | 34346 AGATE TER
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City | FREMONT
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State | CA
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Zip | 94555-3858
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Country | US
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Telephone | 510-676-4087
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Fax | 510-745-0192
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT 16073
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License Number State | CA
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