Provider Demographics
NPI:1639802184
Name:SABLE, SUZETTE ELIZABETH
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:ELIZABETH
Last Name:SABLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1571 FORTALEZA WAY UNIT 36
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-2529
Mailing Address - Country:US
Mailing Address - Phone:619-538-3197
Mailing Address - Fax:
Practice Address - Street 1:2831 CAMINO DEL RIO S STE 203
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3828
Practice Address - Country:US
Practice Address - Phone:858-683-3793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128561106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist