Provider Demographics
NPI:1952479412
Name:THUKRAL, SUSMITA (IMF)
Entity Type:Individual
Prefix:MS
First Name:SUSMITA
Middle Name:
Last Name:THUKRAL
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9445 FARNHAM ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1308
Mailing Address - Country:US
Mailing Address - Phone:619-454-2835
Mailing Address - Fax:858-380-4676
Practice Address - Street 1:2221 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 305
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3608
Practice Address - Country:US
Practice Address - Phone:619-454-2835
Practice Address - Fax:619-220-0437
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9980OtherMEDICAL