Healthcare Provider Details

I. General information

NPI: 1063275477
Provider Name (Legal Business Name): SOURABH ARORA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 SANTA MONICA BLVD STE 105
SANTA MONICA CA
90404-2305
US

IV. Provider business mailing address

13700 MARINA POINTE DR UNIT 1225
MARINA DEL REY CA
90292-9268
US

V. Phone/Fax

Practice location:
  • Phone: 213-214-8738
  • Fax:
Mailing address:
  • Phone: 213-214-8738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME166458
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME166458
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberME166458
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: