Provider Demographics
NPI:1780629386
Name:KATHIRIYA, SUGRA SHIRAZ (MD)
Entity Type:Individual
Prefix:
First Name:SUGRA
Middle Name:SHIRAZ
Last Name:KATHIRIYA
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 1:15651 IMPERIAL HWY
Mailing Address - Street 2:SUITE#103
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1628
Mailing Address - Country:US
Mailing Address - Phone:562-947-9555
Mailing Address - Fax:562-947-9556
Practice Address - Street 1:15651 IMPERIAL HWY
Practice Address - Street 2:SUITE#103
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1628
Practice Address - Country:US
Practice Address - Phone:562-947-9555
Practice Address - Fax:562-947-9556
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35847208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA35847Medicare UPIN