MEDICARE: CAROL SUZUKI

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	225X00000X	Occupational Therapist	3871	CA

General Provider Information

NPI Number	:	1649692260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL SUZUKI

Provider Business Mailing Address
First Line	:	1570 E 17TH ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-8502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6076 BRISTOL PKWY
Second Line	:	SUITE 105
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6600
Country	:	US
Telephone Number	:	562-547-1590
Fax Number	:

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

Provider Enumeration Date	:	01/16/2014
Last Update Date	:	01/16/2014

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