Basic Information
| Provider Information | |||||||||
| NPI: | 1760945935 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAI | ||||||||
| FirstName: | SONAM | ||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 N SUNRISE AVE STE 1105 | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956612931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167718255 | ||||||||
| FaxNumber: | 9167718211 | ||||||||
| Practice Location | |||||||||
| Address1: | 151 N SUNRISE AVE STE 1105 | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956612931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167718255 | ||||||||
| FaxNumber: | 9167718211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2019 | ||||||||
| LastUpdateDate: | 11/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 13353 | CA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 29542 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.