Provider Demographics
NPI:1447361209
Name:WERASOPHON, SAWITRI - (MD)
Entity type:Individual
Prefix:DR
First Name:SAWITRI
Middle Name:-
Last Name:WERASOPHON
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 1:1226 E MCFADDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4106
Mailing Address - Country:US
Mailing Address - Phone:714-542-1331
Mailing Address - Fax:714-542-4758
Practice Address - Street 1:1226 E MCFADDEN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4106
Practice Address - Country:US
Practice Address - Phone:714-542-1331
Practice Address - Fax:714-542-4758
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36565208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A365650Medicaid