Provider Demographics
NPI:1447091095
Name:CHOTHANI, POOJA JITENDRA
Entity type:Individual
Prefix:DR
First Name:POOJA JITENDRA
Middle Name:
Last Name:CHOTHANI
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 1:3010 W LOOP 1604 N APT 6208
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3929
Mailing Address - Country:US
Mailing Address - Phone:361-277-1747
Mailing Address - Fax:
Practice Address - Street 1:14124 CULEBRA RD UNIT 113
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-7648
Practice Address - Country:US
Practice Address - Phone:210-787-1554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX404751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program