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General NPI Number Information
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NPI Number | 1619486644
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Entity Type | Individual
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Provider Name | SUSAN VIRGINIA MASSEY
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Gender | Female
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Dates
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Enumeration Date | 09/21/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 8900 WILSHIRE BLVD STE 300
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-1959
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Country | US
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Telephone | 310-273-8002
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Fax |
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Provider Business Mailing Address
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Address Line | 1041 S CORNING ST APT 203
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City | LOS ANGELES
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State | CA
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Zip | 90035-2040
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Country | US
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Telephone | 631-223-5404
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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 | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 21114
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License Number State | CA
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