Healthcare Provider Details

I. General information

NPI: 1225131857
Provider Name (Legal Business Name): SAOWAREE PONRARTANA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3526 WEST FIRST STREET
SANTA ANA CA
92703-3302
US

IV. Provider business mailing address

19202 DOE RUN
SANTA ANA CA
92705-2861
US

V. Phone/Fax

Practice location:
  • Phone: 714-839-6611
  • Fax: 714-839-6612
Mailing address:
  • Phone: 714-839-6611
  • Fax: 714-839-6612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA35227
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: