Provider Demographics
NPI:1669491106
Name:SIMPSON, SUZANNE MARIE (PDH)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:MARIE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:PDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5580 LA JOLLA BLVD STE 82
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7651
Mailing Address - Country:US
Mailing Address - Phone:760-720-4997
Mailing Address - Fax:760-434-3557
Practice Address - Street 1:5580 LA JOLLA BLVD STE 82
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-7651
Practice Address - Country:US
Practice Address - Phone:760-720-4997
Practice Address - Fax:760-434-3557
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7544103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPV0075440Medicaid
CACP7544Medicare ID - Type Unspecified
CAPV0075440Medicaid