Healthcare Provider Details

I. General information

NPI: 1619533742
Provider Name (Legal Business Name): AMIT SUREEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21832 CACTUS AVE
RIVERSIDE CA
92518-3010
US

IV. Provider business mailing address

21832 CACTUS AVE
RIVERSIDE CA
92518-3010
US

V. Phone/Fax

Practice location:
  • Phone: 951-924-6500
  • Fax:
Mailing address:
  • Phone: 951-924-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2022018807
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number20A22708
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: