Healthcare Provider Details

I. General information

NPI: 1912814286
Provider Name (Legal Business Name): KATHARINE TAYLOR SUCHNIAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1083 GAYLEY AVE FL 3
LOS ANGELES CA
90024-3743
US

IV. Provider business mailing address

6220 S HALM AVE
LOS ANGELES CA
90056-2017
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-5959
  • Fax:
Mailing address:
  • Phone: 310-717-4225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE197259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: