Provider Demographics
NPI:1801816319
Name:VAZIRANI, SONDRA SHANTHI (MD)
Entity Type:Individual
Prefix:DR
First Name:SONDRA
Middle Name:SHANTHI
Last Name:VAZIRANI
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 1:11301 WILSHIRE BLVD
Mailing Address - Street 2:10H1/111
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90073-1003
Mailing Address - Country:US
Mailing Address - Phone:310-268-3125
Mailing Address - Fax:310-268-4818
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:10H1/111
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-268-3125
Practice Address - Fax:310-268-4818
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG63220Medicare UPIN
CAWA55092AMedicare ID - Type UnspecifiedPPIN #