MEDICARE: DR. SUSAN SHARAGA SWADENER PHD, RD

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	133V00000X	Registered Dietitian	R399376

General Provider Information

NPI Number	:	1699958942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN SHARAGA SWADENER PHD, RD

Provider Business Mailing Address
First Line	:	2280 SUNSET DR STE B3
Second Line	:
City	:	LOS OSOS
State	:	CA
Zip	:	93402-4024
Country	:	US
Telephone Number	:	805-528-1926
Fax Number	:

Provider Business Practice Location Address
First Line	:	2280 SUNSET DR STE B3
Second Line	:
City	:	LOS OSOS
State	:	CA
Zip	:	93402-4024
Country	:	US
Telephone Number	:	805-528-1926
Fax Number	:

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

Provider Enumeration Date	:	12/10/2007
Last Update Date	:	12/10/2007

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