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General NPI Number Information
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NPI Number | 1669557286
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Entity Type | Individual
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Provider Name | LAWRENCE E SUESS DO
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 12/17/2020
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Provider Practice Location Address
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Address Line | 1805 N CALIFORNIA ST STE 201
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City | STOCKTON
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State | CA
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Zip | 95204-6032
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Country | US
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Telephone | 209-645-4005
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Fax | 209-645-6344
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Provider Business Mailing Address
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Address Line | 1805 N CALIFORNIA ST STE 201
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City | STOCKTON
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State | CA
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Zip | 95204-6032
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Country | US
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Telephone | 209-645-4005
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Fax | 209-645-6344
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 20A17635
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License Number State | CA
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