MEDICARE: SONAL KHATTRI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A105678	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A105678	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1013997303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONAL KHATTRI MD

Provider Business Mailing Address
First Line	:	PO BOX 28199
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92198-0199
Country	:	US
Telephone Number	:	858-675-3100
Fax Number	:	858-618-1523

Provider Business Practice Location Address
First Line	:	15611 POMERADO RD
Second Line	:	SUITE 400
City	:	POWAY
State	:	CA
Zip	:	92064-2437
Country	:	US
Telephone Number	:	858-675-3170
Fax Number	:	858-675-0518

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	09/08/2015

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