Provider Demographics
NPI:1083093223
Name:AHMED, SUZAN (MA)
Entity Type:Individual
Prefix:
First Name:SUZAN
Middle Name:
Last Name:AHMED
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 CAMINITO EASTBLUFF
Mailing Address - Street 2:UNIT 87
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-2885
Mailing Address - Country:US
Mailing Address - Phone:928-446-8668
Mailing Address - Fax:
Practice Address - Street 1:1440 BROADWAY
Practice Address - Street 2:STE 610
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2041
Practice Address - Country:US
Practice Address - Phone:928-446-8668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program