Healthcare Provider Details

I. General information

NPI: 1417276775
Provider Name (Legal Business Name): SUSAN HUSCROFT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2474 INVERNESS AVE
LOS ANGELES CA
90027-1218
US

IV. Provider business mailing address

2474 INVERNESS AVE
LOS ANGELES CA
90027-1218
US

V. Phone/Fax

Practice location:
  • Phone: 323-661-7676
  • Fax: 323-661-0738
Mailing address:
  • Phone: 323-661-7676
  • Fax: 323-661-0738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAO23972
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: