Healthcare Provider Details

I. General information

NPI: 1992812242
Provider Name (Legal Business Name): SONAL M SUBBU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SONAL M SUBBU M.D.

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 W 24TH ST
YUMA AZ
85364-6122
US

IV. Provider business mailing address

2150 W 24TH STREET
YUMA AZ
85364
US

V. Phone/Fax

Practice location:
  • Phone: 928-819-7000
  • Fax: 928-329-9303
Mailing address:
  • Phone: 928-819-7000
  • Fax: 928-329-9303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number33107
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: