Provider Demographics
NPI:1154512663
Name:GREWAL, SONIA RALLI (MD)
Entity type:Individual
Prefix:DR
First Name:SONIA
Middle Name:RALLI
Last Name:GREWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SONIA
Other - Middle Name:
Other - Last Name:RALLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:351 HOSPITAL RD STE 415
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3507
Mailing Address - Country:US
Mailing Address - Phone:949-548-3177
Mailing Address - Fax:949-548-3412
Practice Address - Street 1:351 HOSPITAL RD STE 415
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3507
Practice Address - Country:US
Practice Address - Phone:949-548-3177
Practice Address - Fax:949-548-3412
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1154512663Medicare UPIN