Healthcare Provider Details

I. General information

NPI: 1851303739
Provider Name (Legal Business Name): SUZANNE MARIE WARE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 SOQUEL AVE
SANTA CRUZ CA
95062-1323
US

IV. Provider business mailing address

2025 SOQUEL AVE
SANTA CRUZ CA
95062-1323
US

V. Phone/Fax

Practice location:
  • Phone: 831-458-5524
  • Fax: 831-458-5886
Mailing address:
  • Phone:
  • Fax: 831-757-8458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA77628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: