Provider Demographics
NPI:1386889889
Name:SURYA, A MEDICAL CORPORATION INC.
Entity type:Organization
Organization Name:SURYA, A MEDICAL CORPORATION INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIJAYALAKSHMI
Authorized Official - Middle Name:S
Authorized Official - Last Name:PRATHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-260-1012
Mailing Address - Street 1:3330 3RD AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5639
Mailing Address - Country:US
Mailing Address - Phone:619-260-1012
Mailing Address - Fax:619-260-1532
Practice Address - Street 1:3330 3RD AVE STE 304
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5639
Practice Address - Country:US
Practice Address - Phone:619-260-1012
Practice Address - Fax:619-260-1532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51136207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty