Healthcare Provider Details

I. General information

NPI: 1427129741
Provider Name (Legal Business Name): SUZANNE LEE MANCHERIAN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 WILSHIRE BLVD STE 1712
LOS ANGELES CA
90048
US

IV. Provider business mailing address

585 S FAIRFAX AVE
LOS ANGELES CA
90036-2035
US

V. Phone/Fax

Practice location:
  • Phone: 323-937-6903
  • Fax: 323-210-7171
Mailing address:
  • Phone: 323-937-6903
  • Fax: 323-937-2035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE4429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: