Healthcare Provider Details

I. General information

NPI: 1386739795
Provider Name (Legal Business Name): SUSAN L HUTCHINSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27151 GREEN HILLS LN
LAGUNA HILLS CA
92653-7531
US

IV. Provider business mailing address

27151 GREEN HILLS LN
LAGUNA HILLS CA
92653-7531
US

V. Phone/Fax

Practice location:
  • Phone: 424-444-7399
  • Fax: 424-253-0814
Mailing address:
  • Phone: 424-444-7399
  • Fax: 424-253-0814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number48346
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: