Provider Demographics
NPI:1144082736
Name:SURAPANENI, SPURTY (LP)
Entity type:Individual
Prefix:
First Name:SPURTY
Middle Name:
Last Name:SURAPANENI
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7725 GATEWAY UNIT 2407
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-5827
Mailing Address - Country:US
Mailing Address - Phone:562-481-5377
Mailing Address - Fax:
Practice Address - Street 1:4000 MACARTHUR BLVD.
Practice Address - Street 2:SUITE 600, EAST TOWER
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-648-3704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32810103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist