Healthcare Provider Details

I. General information

NPI: 1457039778
Provider Name (Legal Business Name): DAVID LESLIE SURUJPAUL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 N ARLINGTON AVE STE 525
RENO NV
89503-4452
US

IV. Provider business mailing address

645 N ARLINGTON AVE STE 525
RENO NV
89503-4452
US

V. Phone/Fax

Practice location:
  • Phone: 775-770-7664
  • Fax:
Mailing address:
  • Phone: 775-770-7664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29359
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: