Healthcare Provider Details

I. General information

NPI: 1598595456
Provider Name (Legal Business Name): ANAGHA SURESH MD CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2438 N PONDEROSA DR STE C209
CAMARILLO CA
93010-2374
US

IV. Provider business mailing address

360 SPINDLEWOOD AVE
CAMARILLO CA
93012-0903
US

V. Phone/Fax

Practice location:
  • Phone: 805-482-0721
  • Fax:
Mailing address:
  • Phone: 949-241-3906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANAGHA SURESH
Title or Position: CEO
Credential: MD
Phone: 949-241-3906