Healthcare Provider Details

I. General information

NPI: 1821233537
Provider Name (Legal Business Name): SUSANNE ELISE EARL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSANNE ELISE GALYON

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD HUNTINGTON HOSPITAL- GME OFFICE
PASADENA CA
91105
US

IV. Provider business mailing address

100 W CALIFORNIA BLVD HUNTINGTON HOSPITAL-GME OFFICE
PASADENA CA
91105
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-5188
  • Fax:
Mailing address:
  • Phone: 626-397-5188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberA128568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: