MEDICARE: SUZANNE KERLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	G52606	CA

General Provider Information

NPI Number	:	1043290828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE KERLEY

Provider Business Mailing Address
First Line	:	PO BOX 1833
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95061-1833
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2911 CHANTICLEER AVE
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95065-1815
Country	:	US
Telephone Number	:	831-477-2350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	01/10/2008

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