Provider Demographics
NPI:1699817221
Name:MISHAL, SUREKHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUREKHA
Middle Name:
Last Name:MISHAL
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 1:14359 PIONEER BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4850
Mailing Address - Country:US
Mailing Address - Phone:562-864-7279
Mailing Address - Fax:562-862-1765
Practice Address - Street 1:14359 PIONEER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4850
Practice Address - Country:US
Practice Address - Phone:562-864-7279
Practice Address - Fax:562-862-1765
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA035164207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW932Medicare ID - Type UnspecifiedHEALTH CENTER
CAW809CMedicare ID - Type UnspecifiedHUMPHREY