Provider Demographics
NPI:1336299973
Name:GANZHORN, SUSAN (PA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:GANZHORN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOLEDAD
Mailing Address - State:CA
Mailing Address - Zip Code:93960-2533
Mailing Address - Country:US
Mailing Address - Phone:831-678-2665
Mailing Address - Fax:831-678-0776
Practice Address - Street 1:600 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOLEDAD
Practice Address - State:CA
Practice Address - Zip Code:93960-2533
Practice Address - Country:US
Practice Address - Phone:831-678-2665
Practice Address - Fax:831-678-0776
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13472363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA13472OtherPA LICENSE