Provider Demographics
NPI:1043748536
Name:ROBERTSON, SUZANNE (RDH)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7440 GIRARD AVE
Mailing Address - Street 2:4
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4313
Mailing Address - Country:US
Mailing Address - Phone:858-752-4571
Mailing Address - Fax:
Practice Address - Street 1:7744 FAY AVE STE 202
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4313
Practice Address - Country:US
Practice Address - Phone:858-752-4571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-26
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14805174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty