Healthcare Provider Details

I. General information

NPI: 1659471829
Provider Name (Legal Business Name): SUSAN CLASTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 E 120TH ST
LOS ANGELES CA
90059-3026
US

IV. Provider business mailing address

373 WALLIS ST
PASADENA CA
91106-4254
US

V. Phone/Fax

Practice location:
  • Phone: 424-338-2801
  • Fax:
Mailing address:
  • Phone: 925-899-1952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberG036171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: