Provider Demographics
NPI:1922468032
Name:SOJITRA, AKANKSHA ASHOKKUMAR
Entity Type:Individual
Prefix:
First Name:AKANKSHA
Middle Name:ASHOKKUMAR
Last Name:SOJITRA
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 1:499 SEAPORT CT STE 101
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-2782
Mailing Address - Country:US
Mailing Address - Phone:408-409-6342
Mailing Address - Fax:
Practice Address - Street 1:499 SEAPORT CT STE 101
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-2782
Practice Address - Country:US
Practice Address - Phone:408-409-6342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25748225100000X
CA296348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist