Provider Demographics
NPI:1972849495
Name:AJMERA, SMITA PANKAJ (RPT)
Entity Type:Individual
Prefix:MRS
First Name:SMITA
Middle Name:PANKAJ
Last Name:AJMERA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34346 AGATE TER
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-3858
Mailing Address - Country:US
Mailing Address - Phone:510-676-4087
Mailing Address - Fax:510-745-0192
Practice Address - Street 1:3550 MOWRY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1460
Practice Address - Country:US
Practice Address - Phone:510-676-4087
Practice Address - Fax:510-745-0192
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 16073261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy