Healthcare Provider Details

I. General information

NPI: 1215914205
Provider Name (Legal Business Name): SONIA CARAO SAWAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12424B MOUNT MESA RD
LAKE ISABELLA CA
93240-9720
US

IV. Provider business mailing address

PO BOX 1997
LAKE ISABELLA CA
93240-1997
US

V. Phone/Fax

Practice location:
  • Phone: 760-379-5631
  • Fax: 760-379-2482
Mailing address:
  • Phone: 760-379-5631
  • Fax: 760-379-2482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC42333
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: