Provider Demographics
NPI:1578733465
Name:SUMA OOMMEN M D INC
Entity type:Organization
Organization Name:SUMA OOMMEN M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUMA
Authorized Official - Middle Name:
Authorized Official - Last Name:OOMMEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-852-8031
Mailing Address - Street 1:24432 MUIRLANDS BLVD STE 219
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-3939
Mailing Address - Country:US
Mailing Address - Phone:949-852-9038
Mailing Address - Fax:
Practice Address - Street 1:24432 MUIRLANDS BLVD STE 219
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-3939
Practice Address - Country:US
Practice Address - Phone:949-852-9038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty