Healthcare Provider Details

I. General information

NPI: 1538207253
Provider Name (Legal Business Name): SUZANNE C. NASH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 05/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 MASON ST
VACAVILLE CA
95688-4646
US

IV. Provider business mailing address

10470 OLD PLACERVILLE RD SUITE 100
SACRAMENTO CA
95827-2539
US

V. Phone/Fax

Practice location:
  • Phone: 707-454-5800
  • Fax: 707-454-5952
Mailing address:
  • Phone: 800-470-0071
  • Fax: 916-731-7877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberG60919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: