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General NPI Number Information
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NPI Number | 1609385640
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Entity Type | Organization
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Legal Business Name | SURYA PSYCHIATRIC CLINIC PLLC
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Dates
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Enumeration Date | 09/21/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7410 N LA CHOLLA BLVD
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City | TUCSON
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State | AZ
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Zip | 85741
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Country | US
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Telephone | 520-639-8576
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Fax | 520-639-8635
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Provider Business Mailing Address
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Address Line | 7410 N LA CHOLLA BLVD
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City | TUCSON
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State | AZ
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Zip | 85741-2306
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Country | US
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Telephone | 520-639-8576
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Fax | 520-639-8635
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Authorized Official
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Title or Position | CEO
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Name | TEJAS B PATEL
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Credential | MD
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Telephone | 814-659-5247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 51977
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License Number State | AZ
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