Provider Demographics
NPI:1235882655
Name:AUJLA, DAXTER RAJESHWAR
Entity Type:Individual
Prefix:MR
First Name:DAXTER
Middle Name:RAJESHWAR
Last Name:AUJLA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DAXTER
Other - Middle Name:RAJESHWAR
Other - Last Name:AUJLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:841 LADERA CORTE, , SAN RAMON
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583
Mailing Address - Country:US
Mailing Address - Phone:925-391-4746
Mailing Address - Fax:
Practice Address - Street 1:841 LADERA CORTE, , SAN RAMON
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583
Practice Address - Country:US
Practice Address - Phone:925-391-4746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44278246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty