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General NPI Number Information
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NPI Number | 1417457508
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Entity Type | Individual
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Provider Name | SUZANNE MACIEL
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Gender | Female
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Dates
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Enumeration Date | 02/15/2018
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Last Update Date | 02/15/2018
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Provider Practice Location Address
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Address Line | 2825 CAPITOL AVE
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City | SACRAMENTO
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State | CA
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Zip | 95816-6039
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Country | US
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Telephone | 916-887-4466
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Fax |
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Provider Business Mailing Address
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Address Line | 130 MERRITT WAY
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City | SACRAMENTO
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State | CA
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Zip | 95864-6955
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Country | US
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Telephone |
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 24538
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License Number State | CA
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