Provider Demographics
NPI:1821067547
Name:MISRA, SMRUTIREKHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SMRUTIREKHA
Middle Name:
Last Name:MISRA
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 1:2301 CAMINO RAMON
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4440
Mailing Address - Country:US
Mailing Address - Phone:925-361-5550
Mailing Address - Fax:925-361-5553
Practice Address - Street 1:2301 CAMINO RAMON
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4440
Practice Address - Country:US
Practice Address - Phone:925-361-5550
Practice Address - Fax:925-361-5553
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA063713207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D1015415OtherCLIA
CABM5745647OtherDEA
CAG76154Medicare UPIN
CACA151769Medicare PIN
CAZZZ267102Medicare ID - Type Unspecified