Healthcare Provider Details

I. General information

NPI: 1366524332
Provider Name (Legal Business Name): SUREKHA SHARMA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2438 N PONDEROSA DR STE 209C
CAMARILLO CA
93010-2374
US

IV. Provider business mailing address

2438 N PONDEROSA DR STE 209C
CAMARILLO CA
93010-2374
US

V. Phone/Fax

Practice location:
  • Phone: 805-482-0721
  • Fax: 805-389-0725
Mailing address:
  • Phone: 805-482-0721
  • Fax: 805-389-0725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA34402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: