Basic Information
Provider Information
NPI: 1619359833
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SODHI
FirstName: MONISH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1020
Address2:  
City: STOCKTON
State: CA
PostalCode: 952013120
CountryCode: US
TelephoneNumber: 2094686000
FaxNumber: 2094687042
Practice Location
Address1: 500 W HOSPITAL RD
Address2:  
City: FRENCH CAMP
State: CA
PostalCode: 952319693
CountryCode: US
TelephoneNumber: 2094686000
FaxNumber: 2094687042
Other Information
ProviderEnumerationDate: 06/24/2015
LastUpdateDate: 05/10/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208D00000XA151476CAY Allopathic & Osteopathic PhysiciansGeneral Practice 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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