=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912232513
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUNANDA M PEJAVAR M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2009
-----------------------------------------------------
Last Update Date | 02/18/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5555 GROSSMONT CENTER DR
-----------------------------------------------------
City | LA MESA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91942-3019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-740-4500
-----------------------------------------------------
Fax | 619-740-8499
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 509015 DEPT 338
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92150-9015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-939-5010
-----------------------------------------------------
Fax | 858-939-5021
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number | A103733
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------