Provider Demographics
NPI:1407886393
Name:STRODTBECK, SUSAN BETH (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BETH
Last Name:STRODTBECK
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 1:710 N EUCLID ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4115
Mailing Address - Country:US
Mailing Address - Phone:714-517-2100
Mailing Address - Fax:714-490-1973
Practice Address - Street 1:710 N EUCLID ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4115
Practice Address - Country:US
Practice Address - Phone:714-517-2100
Practice Address - Fax:714-490-1973
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66140207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G661400Medicaid
CA00G661400Medicaid
CAF85148Medicare UPIN
CAWG66140CMedicare ID - Type Unspecified