Healthcare Provider Details

I. General information

NPI: 1184193088
Provider Name (Legal Business Name): KATIE SUSSE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W SUNSET BLVD # GF1A
LOS ANGELES CA
90069-3701
US

IV. Provider business mailing address

2335 S BENTLEY AVE APT 305
LOS ANGELES CA
90064-5520
US

V. Phone/Fax

Practice location:
  • Phone: 310-276-6772
  • Fax:
Mailing address:
  • Phone: 310-765-0684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number34323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: