Individual
KANAKAVALLI SURESH IYER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2975 SYCAMORE DR, SIMI VALLEY, CA 93065-1201
(805) 955-6900
(805) 955-6063
Mailing address
PO BOX 7001, 1000, TARZANA, CA 91357-7001
(818) 888-7815
(818) 715-1722
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A56234
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A562340
BLUE SHIELD
CA
05
—
00A562340
—
CA
Enumeration date
07/27/2006
Last updated
10/13/2021
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