MEDICARE: DR. SUZANNE LYNN MCNULTY 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
1	208000000X	Pediatrics Physician	A74237	CA

General Provider Information

NPI Number	:	1992892293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUZANNE LYNN MCNULTY M.D.

Provider Business Mailing Address
First Line	:	26161 LA PAZ RD
Second Line	:	SUITE 115
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-5317
Country	:	US
Telephone Number	:	949-206-0001
Fax Number	:	949-206-0011

Provider Business Practice Location Address
First Line	:	26161 LA PAZ RD
Second Line	:	SUITE 115
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-5317
Country	:	US
Telephone Number	:	949-206-0001
Fax Number	:	949-206-0011

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/08/2007

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