Healthcare Provider Details

I. General information

NPI: 1265349096
Provider Name (Legal Business Name): SIUZANNA DAVIDOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14222 VICTORY BLVD APT 301
VAN NUYS CA
91401-6533
US

IV. Provider business mailing address

14222 VICTORY BLVD APT 301
VAN NUYS CA
91401-6533
US

V. Phone/Fax

Practice location:
  • Phone: 818-424-0032
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number95041233
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: