Healthcare Provider Details

I. General information

NPI: 1982940979
Provider Name (Legal Business Name): SUZANNE ADELE HANSON RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZANNE STUEBING RD

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 EL VERANO WAY
BELMONT CA
94002-3625
US

IV. Provider business mailing address

1516 EL VERANO WAY
BELMONT CA
94002-3625
US

V. Phone/Fax

Practice location:
  • Phone: 650-483-8653
  • Fax:
Mailing address:
  • Phone: 650-483-8653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number01056821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: