Healthcare Provider Details

I. General information

NPI: 1629117791
Provider Name (Legal Business Name): DR. SUZANN KRISTIN PIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

12072 WOODED VISTA LN
SAN DIEGO CA
92128-5241
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-6400
  • Fax:
Mailing address:
  • Phone: 858-679-6814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA97248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: