Healthcare Provider Details

I. General information

NPI: 1194896415
Provider Name (Legal Business Name): JOHN DAVID SARROUF D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 05/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69175 RAMON RD BLDG A
CATHEDRAL CITY CA
92234-3344
US

IV. Provider business mailing address

17822 BEACH BLVD SUITE 278
HUNTINGTON BEACH CA
92647-7101
US

V. Phone/Fax

Practice location:
  • Phone: 760-321-6776
  • Fax:
Mailing address:
  • Phone: 714-842-1441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A9645
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: