Healthcare Provider Details

I. General information

NPI: 1548384365
Provider Name (Legal Business Name): MIRANDA E. SURJADI NP MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE # 3D7 SFGH GASTROENTEROLOGY
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

1001 POTRERO AVE # 3D7 SFGH GASTROENTEROLOGY
SAN FRANCISCO CA
94110-3518
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-4776
  • Fax: 415-206-5199
Mailing address:
  • Phone: 415-206-4776
  • Fax: 415-206-5199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License NumberRN546712
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNPF11790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: