Provider Demographics
NPI:1669025961
Name:SMITA SOANS MD MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SMITA SOANS MD MEDICAL CORPORATION
Other - Org Name:SMITA SOANS MD MEDICAL CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SMITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SOAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-800-6858
Mailing Address - Street 1:1226 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-3412
Mailing Address - Country:US
Mailing Address - Phone:310-800-6958
Mailing Address - Fax:
Practice Address - Street 1:1226 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-3412
Practice Address - Country:US
Practice Address - Phone:310-800-6858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty