Healthcare Provider Details

I. General information

NPI: 1144078429
Provider Name (Legal Business Name): SUZZANE SANCHEZ FERRER-MENDOZA RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 4TH ST
SAN RAFAEL CA
94901-5716
US

IV. Provider business mailing address

411 4TH ST
SAN RAFAEL CA
94901-5716
US

V. Phone/Fax

Practice location:
  • Phone: 448-150-0415
  • Fax:
Mailing address:
  • Phone: 415-448-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: