Healthcare Provider Details

I. General information

NPI: 1760429583
Provider Name (Legal Business Name): MONA SARRAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 B VETERANS BLVD
SAN FIDEL NM
87049-0130
US

IV. Provider business mailing address

PO BOX 130 ATTN ACL PROVIDER ENROLLMENT
SAN FIDEL NM
87049-0130
US

V. Phone/Fax

Practice location:
  • Phone: 505-552-5300
  • Fax: 505-552-5490
Mailing address:
  • Phone: 505-552-5300
  • Fax: 505-552-5490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number238371
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: