Healthcare Provider Details

I. General information

NPI: 1619272028
Provider Name (Legal Business Name): SUSAN T KLEEMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2011
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6344 MUIRLANDS DR
LA JOLLA CA
92037-6352
US

IV. Provider business mailing address

6344 MUIRLANDS DR
LA JOLLA CA
92037-6352
US

V. Phone/Fax

Practice location:
  • Phone: 858-459-3685
  • Fax:
Mailing address:
  • Phone: 858-459-3685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberG11451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: