MEDICARE: DR. SALAH SONBOL M.D.

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	207RN0300X	Nephrology Physician	A55966	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922008119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALAH SONBOL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2160
Second Line	:
City	:	MOORPARK
State	:	CA
Zip	:	93020-2160
Country	:	US
Telephone Number	:	805-842-9530
Fax Number	:

Provider Business Practice Location Address
First Line	:	227 W JANSS RD
Second Line	:	SUITE 100
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-1848
Country	:	US
Telephone Number	:	805-496-6051
Fax Number	:	805-496-8532

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	06/17/2020

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