Basic Information
| Provider Information | |||||||||
| NPI: | 1013580232 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VENKATESH | ||||||||
| FirstName: | DIKSHA | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10128 E ESTATES DR | ||||||||
| Address2: | |||||||||
| City: | CUPERTINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950143304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4086379649 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 TROUSDALE DR | ||||||||
| Address2: | |||||||||
| City: | BURLINGAME | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940103207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6506923758 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2021 | ||||||||
| LastUpdateDate: | 07/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 51062 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.