MEDICARE: STEPHANIE SUGGS

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	104100000X	Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689059545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE SUGGS

Provider Business Mailing Address
First Line	:	3789 1/2 3RD AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-4102
Country	:	US
Telephone Number	:	619-630-7260
Fax Number	:

Provider Business Practice Location Address
First Line	:	3789 1/2 3RD AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-4102
Country	:	US
Telephone Number	:	619-630-7260
Fax Number	:

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

Provider Enumeration Date	:	07/21/2015
Last Update Date	:	07/21/2015

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Directions to “ STEPHANIE SUGGS ” Practice Location

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