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General NPI Number Information
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NPI Number | 1689677122
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Entity Type | Individual
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Provider Name | SUSAN CANNING M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/28/2005
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Last Update Date | 04/08/2023
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Provider Practice Location Address
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Address Line | 3966 MARCASEL AVE
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City | LOS ANGELES
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State | CA
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Zip | 90066-4616
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Country | US
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Telephone | 949-482-1930
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Fax | 216-273-9998
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Provider Business Mailing Address
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Address Line | 13600 MARINA POINTE DR UNIT 1507
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City | MARINA DEL REY
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State | CA
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Zip | 90292-9253
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Country | US
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Telephone | 301-704-4398
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | G174181
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License Number State | CA
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