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General NPI Number Information
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NPI Number | 1225564750
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Entity Type | Individual
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Provider Name | LYDIA DHARSHINI SURYAKUMAR MD
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Gender | Female
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Dates
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Enumeration Date | 05/03/2017
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Last Update Date | 06/16/2020
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Provider Practice Location Address
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Address Line | 1200 N VENTURA RD STE E
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City | OXNARD
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State | CA
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Zip | 93030-3827
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Country | US
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Telephone | 805-988-0053
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Fax | 805-988-0554
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Provider Business Mailing Address
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Address Line | 1040 FLYNN RD
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City | CAMARILLO
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State | CA
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Zip | 93012-5092
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Country | US
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Telephone | 805-673-3930
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Fax | 805-659-3217
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A166986
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License Number State | CA
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