Healthcare Provider Details

I. General information

NPI: 1982178687
Provider Name (Legal Business Name): JANIE SU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date: 11/24/2021
Reactivation Date: 12/09/2021

III. Provider practice location address

2338 W ROYAL PALM RD STE J
PHOENIX AZ
85021-9339
US

IV. Provider business mailing address

1001 SNEATH LN STE 200
SAN BRUNO CA
94066-2349
US

V. Phone/Fax

Practice location:
  • Phone: 885-772-8847
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: