MEDICARE: SUZANNA S NEGUSSIE 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	208000000X	Pediatrics Physician	A68336	CA

General Provider Information

NPI Number	:	1326188210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNA S NEGUSSIE MD

Provider Business Mailing Address
First Line	:	3717 S LA BREA AVE STE 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-5354
Country	:	US
Telephone Number	:	323-292-5600
Fax Number	:	323-292-5611

Provider Business Practice Location Address
First Line	:	3717 S LA BREA AVE STE 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-5354
Country	:	US
Telephone Number	:	323-292-5600
Fax Number	:	323-292-5611

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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