Healthcare Provider Details

I. General information

NPI: 1083809560
Provider Name (Legal Business Name): VALERIE SUSSMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 E MAIN ST 204
VENTURA CA
93003-2893
US

IV. Provider business mailing address

2660 E MAIN ST 204
VENTURA CA
93003-2893
US

V. Phone/Fax

Practice location:
  • Phone: 805-643-7500
  • Fax: 805-643-7510
Mailing address:
  • Phone: 805-643-7500
  • Fax: 805-643-7510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA45247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: