Healthcare Provider Details

I. General information

NPI: 1003193665
Provider Name (Legal Business Name): SUZETTA RICHMOND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 FOURTH STREET
SANTA ROSA CA
95404-3601
US

IV. Provider business mailing address

PO BOX 788
HEMET CA
92546-0788
US

V. Phone/Fax

Practice location:
  • Phone: 707-528-6331
  • Fax: 707-528-6587
Mailing address:
  • Phone: 951-929-6260
  • Fax: 951-765-2855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number584003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: