Basic Information
| Provider Information | |||||||||
| NPI: | 1861788564 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANE | ||||||||
| FirstName: | MONA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39263 MISSION BLVD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | FREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945393037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107964500 | ||||||||
| FaxNumber: | 5107964573 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 W COLUMBIA ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328061133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078415145 | ||||||||
| FaxNumber: | 4078415101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2011 | ||||||||
| LastUpdateDate: | 06/27/2016 | ||||||||
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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 | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207W00000X | A136721 | CA | N | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.