Provider Demographics
NPI:1710611975
Name:STEFANAC, SUZI
Entity Type:Individual
Prefix:
First Name:SUZI
Middle Name:
Last Name:STEFANAC
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 1:306 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-3311
Mailing Address - Country:US
Mailing Address - Phone:650-307-5110
Mailing Address - Fax:
Practice Address - Street 1:306 31ST AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-3311
Practice Address - Country:US
Practice Address - Phone:650-312-8721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No376G00000XNursing Service Related ProvidersNursing Home Administrator