Provider Demographics
NPI:1073998472
Name:SHARMA, POOJA (MA, PSYD)
Entity Type:Individual
Prefix:DR
First Name:POOJA
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:MA, PSYD
Other - Prefix:
Other - First Name:POOJA
Other - Middle Name:
Other - Last Name:KHOSLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2311 MARKS DR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1500
Mailing Address - Country:US
Mailing Address - Phone:714-496-9536
Mailing Address - Fax:
Practice Address - Street 1:2311 MARKS DR
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-1500
Practice Address - Country:US
Practice Address - Phone:714-496-9536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT86722106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist