MEDICARE: DR. SUZANNE MAREE DUPEE 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
1	2084P0804X	Child & Adolescent Psychiatry Physician	A63672	CA
2	2084F0202X	Forensic Psychiatry Physician	A63672	CA
3	2084P0800X	Psychiatry Physician	A63672	CA

General Provider Information

NPI Number	:	1306977350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUZANNE MAREE DUPEE MD

Provider Business Mailing Address
First Line	:	PO BOX 10131
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90295-6131
Country	:	US
Telephone Number	:	310-335-1288
Fax Number	:	866-341-8679

Provider Business Practice Location Address
First Line	:	1148 MANHATTAN AVE STE 9
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-5348
Country	:	US
Telephone Number	:	310-335-1288
Fax Number	:	866-341-8679

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	11/05/2010

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