Healthcare Provider Details

I. General information

NPI: 1326188210
Provider Name (Legal Business Name): SUZANNA S NEGUSSIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3717 S LA BREA AVE STE 201
LOS ANGELES CA
90016-5354
US

IV. Provider business mailing address

3717 S LA BREA AVE STE 201
LOS ANGELES CA
90016-5354
US

V. Phone/Fax

Practice location:
  • Phone: 323-292-5600
  • Fax: 323-292-5611
Mailing address:
  • Phone: 323-292-5600
  • Fax: 323-292-5611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA68336
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: