Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | A112298 | CA |
Y | 208200000X | Surgeon | A112298 | CA |
Y | 208600000X | Surgeon | A112298 | CA |
NPI | 1104015387 |
---|---|
Provider Name | Dr. Dilip Suryavanshi |
First Address | Healdsburg, CA 95448-3253 |
Second Address | Healdsburg, CA 95448-3253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2007 |
Last Update Date | 09/07/2019 |