# SURINDRA N. MITRUKA, M.D. A MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619264363
- **Authorized official:** LAWRENCE DEGHETALDI (CEO/MD)
- **Authorized official phone:** (831) 458-5695

## Contact information

- **Practice address:** 1575 SOQUEL DR, SUITE \#C, SANTA CRUZ, CA 95065-1709
- **Practice address phone:** (831) 458-6288
- **Practice address fax:** (831) 477-9026
- **Mailing address:** 2025 SOQUEL AVE, SANTA CRUZ, CA 95062-1323

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | G84058 | CA | Yes |

## Other

- **Enumeration date:** 07/01/2011
- **Last updated:** 02/13/2012