MEDICARE: DR. SUSAN JERIAN 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	207R00000X	Internal Medicine Physician	G67839	CA

General Provider Information

NPI Number	:	1457726440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN JERIAN M.D.

Provider Business Mailing Address
First Line	:	2625 TOWNSGATE RD
Second Line	:	SUITE 330
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-5751
Country	:	US
Telephone Number	:	805-267-1268
Fax Number	:

Provider Business Practice Location Address
First Line	:	2625 TOWNSGATE RD
Second Line	:	SUITE 330
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-5751
Country	:	US
Telephone Number	:	805-267-1268
Fax Number	:

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

Provider Enumeration Date	:	12/02/2015
Last Update Date	:	12/02/2015

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