MEDICARE: SUSAN HUSCROFT 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
1	208000000X	Pediatrics Physician	AO23972	CA

General Provider Information

NPI Number	:	1417276775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN HUSCROFT M.D.

Provider Business Mailing Address
First Line	:	2474 INVERNESS AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-1218
Country	:	US
Telephone Number	:	323-661-7676
Fax Number	:	323-661-0738

Provider Business Practice Location Address
First Line	:	2474 INVERNESS AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-1218
Country	:	US
Telephone Number	:	323-661-7676
Fax Number	:	323-661-0738

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

Provider Enumeration Date	:	05/26/2010
Last Update Date	:	05/26/2010

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