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General NPI Number Information
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NPI Number | 1396018289
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Entity Type | Organization
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Legal Business Name | RAJESH S SURI
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 39350 CIVIC CENTER DR STE 260
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City | FREMONT
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State | CA
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Zip | 94538-2384
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Country | US
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Telephone | 510-931-4310
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Fax | 510-894-0615
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Provider Business Mailing Address
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Address Line | 43575 MISSION BLVD # 529
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City | FREMONT
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State | CA
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Zip | 94539-5831
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Country | US
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Telephone | 510-931-4310
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Fax | 510-894-0615
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAJESH S SURI
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Credential | M.D.
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Telephone | 510-931-4310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A50486
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License Number State | CA
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