Healthcare Provider Details

I. General information

NPI: 1104895069
Provider Name (Legal Business Name): VICTORIA LOASA SUCHER ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3152 N UNIVERSITY AVE STE 220
PROVO UT
84604-4746
US

IV. Provider business mailing address

3152 N UNIVERSITY AVE STE 220
PROVO UT
84604-4746
US

V. Phone/Fax

Practice location:
  • Phone: 801-229-1014
  • Fax: 801-229-1067
Mailing address:
  • Phone: 801-229-1014
  • Fax: 801-229-1067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number5802191-7100
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: