Provider Demographics
NPI:1952061020
Name:SURENDRAN, MANU (NP)
Entity Type:Individual
Prefix:
First Name:MANU
Middle Name:
Last Name:SURENDRAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25109 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-8116
Mailing Address - Country:US
Mailing Address - Phone:951-698-5765
Mailing Address - Fax:951-698-0254
Practice Address - Street 1:25109 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8116
Practice Address - Country:US
Practice Address - Phone:951-698-5765
Practice Address - Fax:951-698-0254
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR228294363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner