Provider Demographics
NPI:1467531277
Name:WILTURNER, SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:WILTURNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:15466 LOS GATOS BLVD, DR. S. WILTURNER
Mailing Address - Street 2:#109-242
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032
Mailing Address - Country:US
Mailing Address - Phone:415-663-5001
Mailing Address - Fax:408-358-3689
Practice Address - Street 1:14901 NATIONAL AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032
Practice Address - Country:US
Practice Address - Phone:408-356-0835
Practice Address - Fax:408-358-3689
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2023-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA73954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H64386Medicare UPIN