Provider Demographics
NPI:1285716332
Name:SONI, SANDEEP ASHU (MD)
Entity type:Individual
Prefix:
First Name:SANDEEP
Middle Name:ASHU
Last Name:SONI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 28849
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92198-0849
Mailing Address - Country:US
Mailing Address - Phone:858-312-5459
Mailing Address - Fax:858-345-3743
Practice Address - Street 1:15644 POMERADO RD
Practice Address - Street 2:SUITE 202
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2400
Practice Address - Country:US
Practice Address - Phone:858-312-5459
Practice Address - Fax:858-345-3743
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA106937207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1285716322Medicaid
CA1285716332Medicare PIN