Provider Demographics
NPI:1114395688
Name:VERAN-TAGUIBAO, SONIA GO (MD)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:GO
Last Name:VERAN-TAGUIBAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3786 ROBINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-8953
Mailing Address - Country:US
Mailing Address - Phone:949-616-8727
Mailing Address - Fax:
Practice Address - Street 1:101 THE CITY BLVD DR S,
Practice Address - Street 2:BLDG 1, 3RD FLOOR, RM 3003
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-456-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA151907207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program