Healthcare Provider Details

I. General information

NPI: 1518517861
Provider Name (Legal Business Name): SUZAN RANDA ABBOUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N BRAND BLVD STE 700
GLENDALE CA
91203-2336
US

IV. Provider business mailing address

5657 8TH AVE
SACRAMENTO CA
95820-1723
US

V. Phone/Fax

Practice location:
  • Phone: 800-516-0975
  • Fax:
Mailing address:
  • Phone: 831-596-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number35165
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: