Healthcare Provider Details

I. General information

NPI: 1962862870
Provider Name (Legal Business Name): SUSAN J WARD MS, NUTRITION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2016
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 W BURBANK BLVD
BURBANK CA
91506-1414
US

IV. Provider business mailing address

302 WASHINGTON ST 246
SAN DIEGO CA
92103-2110
US

V. Phone/Fax

Practice location:
  • Phone: 818-736-9889
  • Fax:
Mailing address:
  • Phone: 310-367-8045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: