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General NPI Number Information
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NPI Number | 1316186513
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Entity Type | Individual
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Provider Name | MS. SOOZAN SOURY
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Gender | Female
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 07/23/2010
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Provider Practice Location Address
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Address Line | 8700 WEST BEVERLY BLVD
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90048-4751
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Country | US
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Telephone | 310-860-9612
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Fax |
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Provider Business Mailing Address
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Address Line | 8700 BEVERLY BLVD
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90048-1804
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Country | US
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Telephone | 310-860-9612
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA20121
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License Number State | CA
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