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General NPI Number Information
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NPI Number | 1093016883
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Entity Type | Individual
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Provider Name | MRS. SPOORTHY SURESH
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Gender | Female
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Dates
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Enumeration Date | 11/09/2010
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Last Update Date | 11/09/2010
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Provider Practice Location Address
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Address Line | 2600 WILLOW PASS RD
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City | CONCORD
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State | CA
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Zip | 94519-2544
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Country | US
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Telephone | 925-689-0895
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Fax |
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Provider Business Mailing Address
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Address Line | 81 6TH CROSS B STREET GANDHINAGAR
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City | BANGALORE
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State | KARNATAKA
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Zip | 560009
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Country | IN
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 60772
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License Number State | CA
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