Provider Demographics
NPI:1972706661
Name:KAMBOJ, SONIA (MD)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:KAMBOJ
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 1:1101 MEDICAL CTR. BLVD.
Mailing Address - Street 2:PEDIATRIC ER
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072
Mailing Address - Country:US
Mailing Address - Phone:504-349-1554
Mailing Address - Fax:504-349-1579
Practice Address - Street 1:1101 MEDICAL CTR. BLVD.
Practice Address - Street 2:PEDIATRIC ER
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072
Practice Address - Country:US
Practice Address - Phone:504-349-1554
Practice Address - Fax:504-349-1579
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA64658207K00000X
DCMD036381208000000X
LA200951208000000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
202I2036293Medicare PIN