Healthcare Provider Details

I. General information

NPI: 1386141232
Provider Name (Legal Business Name): WILLIAM G SUJAN BS, MS, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PRADEEP G SUJAN BS, MS, MBA

II. Dates (important events)

Enumeration Date: 04/08/2018
Last Update Date: 04/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3119 S DURANGO AVE APT 6
LOS ANGELES CA
90034-4315
US

IV. Provider business mailing address

3119 S DURANGO AVE APT 6
LOS ANGELES CA
90034-4315
US

V. Phone/Fax

Practice location:
  • Phone: 310-815-8143
  • Fax:
Mailing address:
  • Phone: 310-815-8143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code102X00000X
TaxonomyPoetry Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 10
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 11
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 12
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: