Provider Demographics
NPI:1083809560
Name:SUSSMAN, VALERIE (MD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:
Last Name:SUSSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 E MAIN ST
Mailing Address - Street 2:204
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2893
Mailing Address - Country:US
Mailing Address - Phone:805-643-7500
Mailing Address - Fax:805-643-7510
Practice Address - Street 1:2660 E MAIN ST
Practice Address - Street 2:204
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2893
Practice Address - Country:US
Practice Address - Phone:805-643-7500
Practice Address - Fax:805-643-7510
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45247208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics