Healthcare Provider Details

I. General information

NPI: 1619501855
Provider Name (Legal Business Name): SUZANNE CODIGA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S OLIVE ST APT 716
LOS ANGELES CA
90014-3022
US

IV. Provider business mailing address

645 W 9TH ST # 110-287
LOS ANGELES CA
90015-1640
US

V. Phone/Fax

Practice location:
  • Phone: 310-869-4779
  • Fax:
Mailing address:
  • Phone: 310-869-4779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number564894
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: