Healthcare Provider Details

I. General information

NPI: 1962650754
Provider Name (Legal Business Name): SUSAN DIAZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN STRITZEL NP

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE
SAN FRANCISCO CA
94143-0136
US

IV. Provider business mailing address

400 PARNASSUS AVE
SAN FRANCISCO CA
94143-0136
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-2191
  • Fax:
Mailing address:
  • Phone: 415-514-2191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number495729
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: