Basic Information
| Provider Information | |||||||||
| NPI: | 1982900973 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MISSION INFECTIOUS DISEASE & INFUSION CONSULTANTS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1770 | ||||||||
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| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919441770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194641165 | ||||||||
| FaxNumber: | 6195671011 | ||||||||
| Practice Location | |||||||||
| Address1: | 15644 POMERADO RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | POWAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920642400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583125459 | ||||||||
| FaxNumber: | 8583453743 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2011 | ||||||||
| LastUpdateDate: | 05/29/2013 | ||||||||
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| AuthorizedOfficialLastName: | SONI | ||||||||
| AuthorizedOfficialFirstName: | SANDEEP | ||||||||
| AuthorizedOfficialMiddleName: | ASHU | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8583125459 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A106937 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | A106937 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.