MEDICARE: MS. SUSAN H. MCLEARAN RDHAP

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
1	124Q00000X	Dental Hygienist	HAP 82	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	147060	OTHER	CA	DELTA DENTAL
2	522590	OTHER	CA	MEDI-CAL AND CCS/GHPP

General Provider Information

NPI Number	:	1184623738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN H. MCLEARAN RDHAP

Provider Business Mailing Address
First Line	:	2010 E BUENA VISTA AVE
Second Line	:
City	:	VISALIA
State	:	CA
Zip	:	93292-2365
Country	:	US
Telephone Number	:	559-733-2355
Fax Number	:	559-625-4578

Provider Business Practice Location Address
First Line	:	2010 E BUENA VISTA AVE
Second Line	:
City	:	VISALIA
State	:	CA
Zip	:	93292-2365
Country	:	US
Telephone Number	:	559-733-2355
Fax Number	:	559-625-4578

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2005
Last Update Date	:	07/08/2007

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