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NPI Code Detail

MEDICARE: SUZY NASSRALLA MD

MEDICARE: SUZY NASSRALLA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianG81844CA

General Provider Information

NPI Number : 1043309354
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUZY NASSRALLA MD
Provider Business Mailing Address
First Line : 2025 SOQUEL AVE
Second Line :
City : SANTA CRUZ
State : CA
Zip : 95062-1323
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7600 OLD DOMINION CT
Second Line :
City : APTOS
State : CA
Zip : 95003-3821
Country : US
Telephone Number : 831-458-6200
Fax Number : 831-479-6659
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 01/16/2012

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Directions to “ SUZY NASSRALLA MD” Practice Location

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