MEDICARE: SURINDER S RARON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A49303	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710943667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SURINDER S RARON MD

Provider Business Mailing Address
First Line	:	3400 DATA DR
Second Line	:	PHYSICIAN SUPPORT SERVICES, 2ND FL
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-7956
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3132 W MARCH LN
Second Line	:	STE. 5
City	:	STOCKTON
State	:	CA
Zip	:	95219-2354
Country	:	US
Telephone Number	:	209-475-5500
Fax Number	:	209-475-5503

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	10/06/2014

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