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NPI Code Detail

MEDICARE: DR. SUSAN CANNING M.D.

MEDICARE: DR. SUSAN CANNING M.D.
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
1207N00000XDermatology PhysicianG174181CA

General Provider Information

NPI Number : 1689677122
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAN CANNING M.D.
Provider Business Mailing Address
First Line : 13600 MARINA POINTE DR UNIT 1507
Second Line :
City : MARINA DEL REY
State : CA
Zip : 90292-9253
Country : US
Telephone Number : 301-704-4398
Fax Number :
Provider Business Practice Location Address
First Line : 3966 MARCASEL AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90066-4616
Country : US
Telephone Number : 949-482-1930
Fax Number : 216-273-9998
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2005
Last Update Date : 04/08/2023

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