Healthcare Provider Details

I. General information

NPI: 1245501899
Provider Name (Legal Business Name): SURAJ RASANIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 07/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 N 13TH AVE STE 9
UPLAND CA
91786-4963
US

IV. Provider business mailing address

685 N 13TH AVE SUITE 9
UPLAND CA
91786-4963
US

V. Phone/Fax

Practice location:
  • Phone: 909-981-8383
  • Fax: 909-920-3054
Mailing address:
  • Phone: 909-981-8383
  • Fax: 909-920-3054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number250554
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD455830
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA148534
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: