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General NPI Number Information
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NPI Number | 1518517861
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Entity Type | Individual
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Provider Name | SUZAN RANDA ABBOUD
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Gender | Female
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 330 N BRAND BLVD STE 700
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City | GLENDALE
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State | CA
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Zip | 91203-2336
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Country | US
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Telephone | 800-516-0975
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Fax |
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Provider Business Mailing Address
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Address Line | 5657 8TH AVE
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City | SACRAMENTO
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State | CA
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Zip | 95820-1723
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Country | US
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Telephone | 831-596-2120
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 35165
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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