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NPI Code Detail

MEDICARE: DR. SUZANNE Y HOMER M.D.

MEDICARE: DR. SUZANNE Y HOMER M.D.
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
12085R0202XDiagnostic Radiology PhysicianA73381CA

General Provider Information

NPI Number : 1194767582
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUZANNE Y HOMER M.D.
Provider Business Mailing Address
First Line : 5767 W CENTURY BLVD STE 400
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-5631
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 501 DEEP VALLEY DR STE 100
Second Line :
City : ROLLING HILLS ESTATES
State : CA
Zip : 90274-7606
Country : US
Telephone Number : 310-303-3953
Fax Number : 310-303-7903
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 12/13/2019

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