Provider Demographics
NPI:1467632190
Name:DAVIS, SUSANN PAULETTE (RN)
Entity Type:Individual
Prefix:MRS
First Name:SUSANN
Middle Name:PAULETTE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13039 LAKEVIEW GRANADA DR
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-4719
Mailing Address - Country:US
Mailing Address - Phone:619-561-0270
Mailing Address - Fax:
Practice Address - Street 1:1094 CUDAHY PL STE 314
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3924
Practice Address - Country:US
Practice Address - Phone:619-561-0270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health