Provider Demographics
NPI:1619533742
Name:SUREEN, AMIT (DO)
Entity type:Individual
Prefix:
First Name:AMIT
Middle Name:
Last Name:SUREEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21832 CACTUS AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92518-3010
Mailing Address - Country:US
Mailing Address - Phone:951-924-6500
Mailing Address - Fax:
Practice Address - Street 1:21832 CACTUS AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92518-3010
Practice Address - Country:US
Practice Address - Phone:951-924-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022018807207RR0500X
390200000X
CA20A22708207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program