Type 1 · Individual ✓ Active NPI ✓ Valid NPI checksum

Dr. Mira Surjanto, PHARM.D.

Pharmacist in Vallejo, CA · enumerated 2006.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1124110705

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Registry record

Entity type Individual (Type 1)

Name Dr. Mira Surjanto

Credential PHARM.D.

Sex Female

Practice address 975 Sereno Dr, Mob Medicine 7, Vallejo, CA, 94589

Phone (707) 651-2584

Enumeration date Sep 29, 2006

Last updated in NPPES Jul 8, 2007

Taxonomy & licenses

183500000X Pharmacist Pharmacy Service Providers · License 51280 (CA) Primary

PHARMD · Doctor of Pharmacy: A licensed pharmacist with a professional doctorate in pharmacy. About the PHARMD credential

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

Read the full guide → Validate an NPI →

Frequently asked questions

Where does Mira Surjanto practice?

The practice location on file with NPPES is in Vallejo, CA. Providers can have multiple locations; NPPES lists the primary practice address.

What is the NPI number for Mira Surjanto?

The National Provider Identifier (NPI) for Mira Surjanto is 1124110705, a Type 1 (individual) record in the CMS NPPES registry.

Other providers at this practice address

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2007-07-08.