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General NPI Number Information
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NPI Number | 1598887929
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Entity Type | Individual
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Provider Name | SUSANNAH SUNDERLAND L.AC
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Gender | Female
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Dates
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Enumeration Date | 04/05/2007
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Last Update Date | 08/08/2007
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Provider Practice Location Address
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Address Line | 317 N EL CAMINO REAL SUITE 401
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City | ENCINITAS
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State | CA
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Zip | 92024-2811
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Country | US
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Telephone | 760-688-8814
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Fax | 760-683-6944
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Provider Business Mailing Address
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Address Line | PO BOX 130638
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City | CARLSBAD
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State | CA
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Zip | 92013-0638
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Country | US
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Telephone | 760-688-8814
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Fax | 760-683-6944
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 10926
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License Number State | CA
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