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General NPI Number Information
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NPI Number | 1780932871
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Entity Type | Individual
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Provider Name | SUSAN M CUNNINGHAM
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Gender | Female
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Dates
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Enumeration Date | 08/21/2012
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Last Update Date | 12/02/2021
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Provider Practice Location Address
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Address Line | 1200 W HILLCREST DR
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City | THOUSAND OAKS
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State | CA
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Zip | 91320-2734
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Country | US
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Telephone | 805-498-6470
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Fax |
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Provider Business Mailing Address
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Address Line | 2089 MONTROSE DR
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City | THOUSAND OAKS
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State | CA
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Zip | 91362-2434
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Country | US
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Telephone | 805-496-3302
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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 | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number | 18428
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License Number State | CA
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