Provider Demographics
NPI:1497752778
Name:SONGSANAND, NUALHATHAI PRISCILLA (MD)
Entity Type:Individual
Prefix:
First Name:NUALHATHAI
Middle Name:PRISCILLA
Last Name:SONGSANAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:
Other - Last Name:SONGSANAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:16197 CROWN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1210
Mailing Address - Country:US
Mailing Address - Phone:760-245-3230
Mailing Address - Fax:
Practice Address - Street 1:14075 HESPERIA RD
Practice Address - Street 2:STE 101
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4500
Practice Address - Country:US
Practice Address - Phone:760-245-3230
Practice Address - Fax:760-245-7215
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81254207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H98709Medicare UPIN
00A812540Medicare ID - Type Unspecified