Provider Demographics
NPI:1154467132
Name:WATERS, SUSAN DEAN
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:DEAN
Last Name:WATERS
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 1:1134 TEMPLE DR
Mailing Address - Street 2:
Mailing Address - City:PACHECO
Mailing Address - State:CA
Mailing Address - Zip Code:94553-5112
Mailing Address - Country:US
Mailing Address - Phone:925-691-5841
Mailing Address - Fax:
Practice Address - Street 1:1200 MT DIABLO BLVD
Practice Address - Street 2:SUITE 312
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4852
Practice Address - Country:US
Practice Address - Phone:925-943-1794
Practice Address - Fax:925-943-6091
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker