Healthcare Provider Details

I. General information

NPI: 1225156425
Provider Name (Legal Business Name): SUSAN FRUGONE MIZIKER MA, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN J. FRUGONE MA, CCC-A

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6333 WILSHIRE BLVD SUITE 309
LOS ANGELES CA
90048-5702
US

IV. Provider business mailing address

4638 LEDGE AVE
TOLUCA LAKE CA
91602-1536
US

V. Phone/Fax

Practice location:
  • Phone: 323-651-5107
  • Fax: 323-651-4169
Mailing address:
  • Phone: 818-761-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU1281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: