Healthcare Provider Details

I. General information

NPI: 1982126314
Provider Name (Legal Business Name): SUZANNE FISCHER COMELO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 16TH ST
OAKLAND CA
94612-1520
US

IV. Provider business mailing address

25518 CONLEY DOWNS DR
CASTRO VALLEY CA
94552-5497
US

V. Phone/Fax

Practice location:
  • Phone: 510-357-5515
  • Fax:
Mailing address:
  • Phone: 415-412-1458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: