Provider Demographics
NPI:1013415082
Name:MD HEALTH NETWORK INC
Entity Type:Organization
Organization Name:MD HEALTH NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANJANA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-726-2255
Mailing Address - Street 1:1336 W WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4601
Mailing Address - Country:US
Mailing Address - Phone:323-726-2255
Mailing Address - Fax:
Practice Address - Street 1:1336 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4601
Practice Address - Country:US
Practice Address - Phone:323-726-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty