Healthcare Provider Details

I. General information

NPI: 1376589663
Provider Name (Legal Business Name): SURENDER PAL SINGH PUNIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 GREGORY LN STE 20
PLEASANT HILL CA
94523-4925
US

IV. Provider business mailing address

PO BOX 789
DANVILLE CA
94526-0789
US

V. Phone/Fax

Practice location:
  • Phone: 925-825-1766
  • Fax:
Mailing address:
  • Phone: 925-825-1766
  • Fax: 925-825-1763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberA77004
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA77004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: