Provider Demographics
NPI:1891297834
Name:SURAJ RASANIA MD INC
Entity Type:Organization
Organization Name:SURAJ RASANIA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SURAJ
Authorized Official - Middle Name:P
Authorized Official - Last Name:RASANIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-942-9358
Mailing Address - Street 1:299 W FOOTHILL BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3806
Mailing Address - Country:US
Mailing Address - Phone:909-949-8866
Mailing Address - Fax:909-385-0379
Practice Address - Street 1:811 E 11TH ST STE 203
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4872
Practice Address - Country:US
Practice Address - Phone:909-942-9358
Practice Address - Fax:909-912-8043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA148534207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty