Individual
DR. NISSI SHARON SUPPOGU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
3828 SCHAUFELE AVE, STE. 250, LONG BEACH, CA 90808
(657) 241-8990
(714) 665-4664
Mailing address
3828 SCHAUFELE AVE, STE. 250, LONG BEACH, CA 90808
(657) 241-8990
(714) 665-4664
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A146165
CA
207RC0000X
Cardiovascular Disease Physician
Primary
A146165
CA
Other
Enumeration date
06/25/2013
Last updated
04/30/2026
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