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General NPI Number Information
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NPI Number | 1902186943
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Entity Type | Organization
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Legal Business Name | ANJANA S SURA M.D. INC.
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Dates
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Enumeration Date | 08/23/2011
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 1336 W WHITTIER BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-4601
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Country | US
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Telephone | 323-459-3878
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Fax |
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Provider Business Mailing Address
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Address Line | 714 HAMPTON RD
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City | ARCADIA
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State | CA
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Zip | 91006-2003
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Country | US
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Telephone | 323-459-3878
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANJANA S SURA
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Credential | MD
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Telephone | 323-726-2255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0000X
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Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
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License Number | A30390
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License Number State | CA
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