Provider Demographics
NPI:1710676085
Name:RATHOD, JISHITA
Entity Type:Individual
Prefix:
First Name:JISHITA
Middle Name:
Last Name:RATHOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JISHITA
Other - Middle Name:RATHOD
Other - Last Name:KATBAMNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 MIRLO
Mailing Address - Street 2:
Mailing Address - City:RSM
Mailing Address - State:CA
Mailing Address - Zip Code:92688-1614
Mailing Address - Country:US
Mailing Address - Phone:949-310-5798
Mailing Address - Fax:
Practice Address - Street 1:18 MIRLO
Practice Address - Street 2:
Practice Address - City:RSM
Practice Address - State:CA
Practice Address - Zip Code:92688-1614
Practice Address - Country:US
Practice Address - Phone:949-310-5798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025015363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care