Provider Demographics
NPI:1073679007
Name:ONIKUL-ROSS, SUZANNE RHONDA (PHD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:RHONDA
Last Name:ONIKUL-ROSS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CORPORATE PARK
Mailing Address - Street 2:STE 240
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-3100
Mailing Address - Country:US
Mailing Address - Phone:949-852-1961
Mailing Address - Fax:949-852-0220
Practice Address - Street 1:7 CORPORATE PARK
Practice Address - Street 2:SUITE 235
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5107
Practice Address - Country:US
Practice Address - Phone:949-852-1961
Practice Address - Fax:949-852-0220
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13933103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWCP13933AMedicare ID - Type Unspecified