Provider Demographics
NPI:1477689651
Name:PURI, SURINDER PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:SURINDER
Middle Name:PAUL
Last Name:PURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23160 HATTERAS ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-4237
Mailing Address - Country:US
Mailing Address - Phone:818-349-9966
Mailing Address - Fax:
Practice Address - Street 1:9346 CORBIN AVE
Practice Address - Street 2:AV
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2405
Practice Address - Country:US
Practice Address - Phone:818-349-9966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40165146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant