Healthcare Provider Details

I. General information

NPI: 1912761503
Provider Name (Legal Business Name): SURAIYA RAHMAN MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 E WALNUT ST STE 214
PASADENA CA
91106-5361
US

IV. Provider business mailing address

243 WALLIS ST UNIT 4
PASADENA CA
91106-5419
US

V. Phone/Fax

Practice location:
  • Phone: 626-808-4080
  • Fax: 626-669-4080
Mailing address:
  • Phone: 626-278-8727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SURAIYA SIMI RAHMAN
Title or Position: OWNER
Credential: MD
Phone: 626-808-4080