Provider Demographics
NPI:1346396132
Name:SOUTH, SUZAN VICTORIA (RNP)
Entity Type:Individual
Prefix:
First Name:SUZAN
Middle Name:VICTORIA
Last Name:SOUTH
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6208 ORION AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1022
Mailing Address - Country:US
Mailing Address - Phone:818-994-1943
Mailing Address - Fax:818-994-1999
Practice Address - Street 1:7345 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1910
Practice Address - Country:US
Practice Address - Phone:818-348-6200
Practice Address - Fax:818-348-6233
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN484250 NP6940363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health