Provider Demographics
NPI:1871559898
Name:RAHMAN, SURAIYA SIMI (MD)
Entity type:Individual
Prefix:
First Name:SURAIYA
Middle Name:SIMI
Last Name:RAHMAN
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 1:243 WALLIS ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-5419
Mailing Address - Country:US
Mailing Address - Phone:626-278-8727
Mailing Address - Fax:
Practice Address - Street 1:243 WALLIS ST UNIT 4
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-5419
Practice Address - Country:US
Practice Address - Phone:626-278-8727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54271208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209308105Medicaid
KS200300230BMedicare ID - Type Unspecified
I24414Medicare UPIN
MO209308105Medicaid