Healthcare Provider Details

I. General information

NPI: 1154393262
Provider Name (Legal Business Name): SONIYA S GANDHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PLZ
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

200 MEDICAL PLZ 365 C
LOS ANGELES CA
90095-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-6553
  • Fax: 310-825-3632
Mailing address:
  • Phone: 310-794-6553
  • Fax: 310-825-3632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA116230
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number240219
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA116230
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: