Provider Demographics
NPI:1669844312
Name:KHAMBETE, SONALI
Entity Type:Individual
Prefix:
First Name:SONALI
Middle Name:
Last Name:KHAMBETE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 ARCADIA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-6610
Mailing Address - Country:US
Mailing Address - Phone:408-564-4439
Mailing Address - Fax:
Practice Address - Street 1:54 N SANTA CRUZ AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-5932
Practice Address - Country:US
Practice Address - Phone:408-395-1867
Practice Address - Fax:408-395-1947
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA618141835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care