Healthcare Provider Details

I. General information

NPI: 1275656860
Provider Name (Legal Business Name): SUZANNE MCDONNELL GIRAUDO ED.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 CALIFORNIA ST
SAN FRANCISCO CA
94118-1618
US

IV. Provider business mailing address

35 SAN BUENAVENTURA WAY
SAN FRANCISCO CA
94127-1515
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-6200
  • Fax:
Mailing address:
  • Phone: 415-600-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number13463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: