Healthcare Provider Details

I. General information

NPI: 1952928178
Provider Name (Legal Business Name): SUSANA METZTLI DURAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2020
Last Update Date: 07/03/2020
Certification Date: 07/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 MISSION ST
SAN FRANCISCO CA
94110-3917
US

IV. Provider business mailing address

540 CAPP ST APT 107
SAN FRANCISCO CA
94110-2530
US

V. Phone/Fax

Practice location:
  • Phone: 415-229-0500
  • Fax:
Mailing address:
  • Phone: 408-620-2122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: