MEDICARE: SUZANNE PATRICE IAZZETTA

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1972251254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE PATRICE IAZZETTA

Provider Business Mailing Address
First Line	:	2101 E 2ND ST UNIT 203
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-5112
Country	:	US
Telephone Number	:	973-913-4693
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 E 2ND ST UNIT 203
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-5112
Country	:	US
Telephone Number	:	973-913-4693
Fax Number	:

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

Provider Enumeration Date	:	03/15/2022
Last Update Date	:	03/15/2022

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Directions to “ SUZANNE PATRICE IAZZETTA ” Practice Location

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