Provider Demographics
NPI:1013997303
Name:KHATTRI, SONAL (MD)
Entity Type:Individual
Prefix:
First Name:SONAL
Middle Name:
Last Name:KHATTRI
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:PO BOX 28199
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92198-0199
Mailing Address - Country:US
Mailing Address - Phone:858-675-3100
Mailing Address - Fax:858-618-1523
Practice Address - Street 1:15611 POMERADO RD
Practice Address - Street 2:SUITE 400
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2437
Practice Address - Country:US
Practice Address - Phone:858-675-3170
Practice Address - Fax:858-675-0518
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105678208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA105678OtherMEDICAL LICENSE
INI30878Medicare UPIN
IN200521630Medicaid
IN202790PPMedicare ID - Type Unspecified
INM400063153Medicare PIN