Provider Demographics
NPI:1235974098
Name:BAKSHI, POOJA (AMFT/APCC)
Entity type:Individual
Prefix:MISS
First Name:POOJA
Middle Name:
Last Name:BAKSHI
Suffix:
Gender:F
Credentials:AMFT/APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11545 CAMINITO LA BAR UNIT 65
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-6009
Mailing Address - Country:US
Mailing Address - Phone:858-226-0107
Mailing Address - Fax:
Practice Address - Street 1:8058 LA MESA BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0335
Practice Address - Country:US
Practice Address - Phone:619-463-9742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16692101YP2500X
CA147154106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional