Provider Demographics
NPI:1093303893
Name:YEPREMYAN, SUSAN GEORGETTA
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:GEORGETTA
Last Name:YEPREMYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14318 KITTRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4709
Mailing Address - Country:US
Mailing Address - Phone:818-378-5353
Mailing Address - Fax:
Practice Address - Street 1:14318 KITTRIDGE ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4709
Practice Address - Country:US
Practice Address - Phone:818-378-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program