Healthcare Provider Details

I. General information

NPI: 1881951887
Provider Name (Legal Business Name): ANAGHA SURESH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N VENTURA RD SUITE 5
OXNARD CA
93030-3836
US

IV. Provider business mailing address

1040 FLYNN RD
CAMARILLO CA
93012-5092
US

V. Phone/Fax

Practice location:
  • Phone: 805-988-1225
  • Fax: 805-278-7186
Mailing address:
  • Phone: 805-673-3930
  • Fax: 805-659-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA118247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: