Healthcare Provider Details

I. General information

NPI: 1184817322
Provider Name (Legal Business Name): SUZANNE L JED MSN, APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZANNE HUFFMAN MSN, APRN-BC

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 MARENGO ST HRA 300
LOS ANGELES CA
90033-1036
US

IV. Provider business mailing address

1640 MARENGO ST HRA 300
LOS ANGELES CA
90033-1036
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-2200
  • Fax: 323-226-2505
Mailing address:
  • Phone: 323-226-2200
  • Fax: 323-226-2505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: