Healthcare Provider Details

I. General information

NPI: 1356503882
Provider Name (Legal Business Name): SONAL JANDIAL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E DEL MAR BLVD STE 104
PASADENA CA
91105-2551
US

IV. Provider business mailing address

1200 N STATE ST
LOS ANGELES CA
90033-1029
US

V. Phone/Fax

Practice location:
  • Phone: 626-657-6625
  • Fax: 626-406-3838
Mailing address:
  • Phone: 323-442-4000
  • Fax: 323-442-4003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A11599
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number20A11599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: