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NPI Code Detail

MEDICARE: KRISTI MARIE SUSCA RDN

MEDICARE: KRISTI MARIE SUSCA RDN
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
1133V00000XRegistered Dietitian86092423CA

General Provider Information

NPI Number : 1700485471
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTI MARIE SUSCA RDN
Provider Business Mailing Address
First Line : 42050 JENNY LN
Second Line :
City : LANCASTER
State : CA
Zip : 93536-7325
Country : US
Telephone Number : 661-916-9378
Fax Number :
Provider Business Practice Location Address
First Line : 1111 COLUMBUS ST STE 3000
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93305-1939
Country : US
Telephone Number : 661-326-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2020
Last Update Date : 12/07/2020

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Directions to “ KRISTI MARIE SUSCA RDN” Practice Location

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