Provider Demographics
NPI:1710126727
Name:SUMA KIDS,INC
Entity Type:Organization
Organization Name:SUMA KIDS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:925-676-9165
Mailing Address - Street 1:1190 BURNETT AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-5640
Mailing Address - Country:US
Mailing Address - Phone:925-676-9165
Mailing Address - Fax:925-676-9166
Practice Address - Street 1:1190 BURNETT AVE
Practice Address - Street 2:SUITE D
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5640
Practice Address - Country:US
Practice Address - Phone:925-676-9165
Practice Address - Fax:925-676-9166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3805225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty