Healthcare Provider Details

I. General information

NPI: 1558595496
Provider Name (Legal Business Name): ARISARA SUWANGOMOLKUL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 COHASSET RD STE 100
CHICO CA
95926-5513
US

IV. Provider business mailing address

PO BOX 6789
CHICO CA
95927-6789
US

V. Phone/Fax

Practice location:
  • Phone: 530-892-2300
  • Fax: 530-894-5890
Mailing address:
  • Phone: 530-892-2300
  • Fax: 530-894-5890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number247533-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA112389
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: