Provider Demographics
NPI:1598595456
Name:ANAGHA SURESH MD CORPORATION
Entity type:Organization
Organization Name:ANAGHA SURESH MD CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANAGHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SURESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-241-3906
Mailing Address - Street 1:360 SPINDLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-0903
Mailing Address - Country:US
Mailing Address - Phone:949-241-3906
Mailing Address - Fax:
Practice Address - Street 1:2438 N PONDEROSA DR STE C209
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2374
Practice Address - Country:US
Practice Address - Phone:805-482-0721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty