Healthcare Provider Details

I. General information

NPI: 1477948750
Provider Name (Legal Business Name): SUZI ELIZABETH DESMOND M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZI ELIZABETH POWERS M.S.

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MASONIC AVENUE
SAN FRANCISCO CA
94118
US

IV. Provider business mailing address

100 MASONIC AVENUE
SAN FRANCISCO CA
94118
US

V. Phone/Fax

Practice location:
  • Phone: 415-567-8370
  • Fax:
Mailing address:
  • Phone: 415-567-8370
  • Fax: 415-292-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF85786
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: