Healthcare Provider Details

I. General information

NPI: 1417652918
Provider Name (Legal Business Name): SONIA PURI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/27/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S STE 835
ORANGE CA
92868-3201
US

IV. Provider business mailing address

11548 TRAILWAY DR
RIVERSIDE CA
92505-3473
US

V. Phone/Fax

Practice location:
  • Phone: 714-480-2440
  • Fax:
Mailing address:
  • Phone: 626-340-6485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA199996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: