Provider Demographics
NPI:1326188210
Name:NEGUSSIE, SUZANNA S (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNA
Middle Name:S
Last Name:NEGUSSIE
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 1:3717 S LA BREA AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-5354
Mailing Address - Country:US
Mailing Address - Phone:323-292-5600
Mailing Address - Fax:323-292-5611
Practice Address - Street 1:3717 S LA BREA AVE STE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-5354
Practice Address - Country:US
Practice Address - Phone:323-292-5600
Practice Address - Fax:323-292-5611
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68336208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics