Provider Demographics
NPI:1033736848
Name:SEAN, SUE (CP CFM)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:SEAN
Suffix:
Gender:F
Credentials:CP CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 W OLYMPIC BLVD STE 123
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-3734
Mailing Address - Country:US
Mailing Address - Phone:213-383-9212
Mailing Address - Fax:213-383-6421
Practice Address - Street 1:1830 W OLYMPIC BLVD STE 123
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-3734
Practice Address - Country:US
Practice Address - Phone:213-383-9212
Practice Address - Fax:213-383-6421
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACFM02641224900000X
CACP003476224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP003476OtherABCOP,