Provider Demographics
NPI:1225416183
Name:SHARMA, PUJA JR (MASTERS')
Entity Type:Individual
Prefix:MISS
First Name:PUJA
Middle Name:
Last Name:SHARMA
Suffix:JR
Gender:F
Credentials:MASTERS'
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25793 VAN LEUVEN ST
Mailing Address - Street 2:APT 120
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2593
Mailing Address - Country:US
Mailing Address - Phone:626-600-2530
Mailing Address - Fax:
Practice Address - Street 1:25793 VAN LEUVEN ST
Practice Address - Street 2:APT 120
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2593
Practice Address - Country:US
Practice Address - Phone:626-600-2530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 16433235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist