MEDICARE: DR. SUZANNE L WESTPHAL MD

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	207N00000X	Dermatology Physician	036-083365	IL
2	207N00000X	Dermatology Physician	G89217	CA

General Provider Information

NPI Number	:	1780676908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUZANNE L WESTPHAL MD

Provider Business Mailing Address
First Line	:	2330 MARINSHIP WAY STE 370
Second Line	:
City	:	SAUSALITO
State	:	CA
Zip	:	94965-2853
Country	:	US
Telephone Number	:	415-887-9758
Fax Number	:	415-887-9763

Provider Business Practice Location Address
First Line	:	2330 MARINSHIP WAY STE 370
Second Line	:
City	:	SAUSALITO
State	:	CA
Zip	:	94965-2853
Country	:	US
Telephone Number	:	415-887-9758
Fax Number	:	415-887-9763

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	03/21/2019

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