Healthcare Provider Details

I. General information

NPI: 1649397167
Provider Name (Legal Business Name): SUZANNE SIEDLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 FROST ST SUITE 410
SAN DIEGO CA
92123-2771
US

IV. Provider business mailing address

7148 COTTINGTON LN
SAN DIEGO CA
92139-2936
US

V. Phone/Fax

Practice location:
  • Phone: 858-514-3710
  • Fax:
Mailing address:
  • Phone: 619-475-8578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number267459
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: