Provider Demographics
NPI:1710432430
Name:KHIRASARIA, POOJA
Entity Type:Individual
Prefix:
First Name:POOJA
Middle Name:
Last Name:KHIRASARIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5295 CAMERON DR APT 103
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1379
Mailing Address - Country:US
Mailing Address - Phone:714-397-9953
Mailing Address - Fax:
Practice Address - Street 1:5295 CAMERON DR APT 103
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-1379
Practice Address - Country:US
Practice Address - Phone:714-397-9953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210624225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist