Provider Demographics
NPI:1891008736
Name:SURYAWALA, KOMAL (RDMS)
Entity Type:Individual
Prefix:
First Name:KOMAL
Middle Name:
Last Name:SURYAWALA
Suffix:
Gender:F
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 E STEARNS ST
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-4745
Mailing Address - Country:US
Mailing Address - Phone:714-457-9284
Mailing Address - Fax:
Practice Address - Street 1:2999 E STEARNS ST
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4745
Practice Address - Country:US
Practice Address - Phone:714-457-9284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA961822471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography