Provider Demographics
NPI:1629285408
Name:COUFAL, SANDRA ISABEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:ISABEL
Last Name:COUFAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:18313 CALLE LA SERRA
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92091-0119
Mailing Address - Country:US
Mailing Address - Phone:858-759-5175
Mailing Address - Fax:858-759-0813
Practice Address - Street 1:10675 JOHN J HOPKINS DR
Practice Address - Street 2:E113
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1127
Practice Address - Country:US
Practice Address - Phone:858-812-1798
Practice Address - Fax:858-759-0813
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA52101207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA52101BMedicare ID - Type Unspecified
CAF67986Medicare UPIN