Healthcare Provider Details

I. General information

NPI: 1952310328
Provider Name (Legal Business Name): SUSAN RUTH CARVALHO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 DE SOTO AVE
CHATSWORTH CA
91311-4409
US

IV. Provider business mailing address

2614 W CHANDLER BLVD
BURBANK CA
91505-2635
US

V. Phone/Fax

Practice location:
  • Phone: 818-882-8100
  • Fax: 818-700-8255
Mailing address:
  • Phone: 818-882-8100
  • Fax: 818-700-8255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number6285
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: