Provider Demographics
NPI:1578855995
Name:CHOUDHARI, SUVARNA (MD)
Entity Type:Individual
Prefix:
First Name:SUVARNA
Middle Name:
Last Name:CHOUDHARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 LAS TABLAS RD
Mailing Address - Street 2:B3
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9703
Mailing Address - Country:US
Mailing Address - Phone:805-296-7816
Mailing Address - Fax:
Practice Address - Street 1:959 LAS TABLAS RD
Practice Address - Street 2:B3
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9703
Practice Address - Country:US
Practice Address - Phone:805-296-7816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA130124207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine