Provider Demographics
NPI:1366524332
Name:SHARMA, SUREKHA (MD)
Entity type:Individual
Prefix:
First Name:SUREKHA
Middle Name:
Last Name:SHARMA
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 1:2438 N PONDEROSA DR STE 209C
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2374
Mailing Address - Country:US
Mailing Address - Phone:805-482-0721
Mailing Address - Fax:805-389-0725
Practice Address - Street 1:2438 N PONDEROSA DR STE 209C
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2374
Practice Address - Country:US
Practice Address - Phone:805-482-0721
Practice Address - Fax:805-389-0725
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34402208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A344020Medicaid
CA00A344020Medicaid