Provider Demographics
NPI:1720395163
Name:STAPATYANON, SUANGSMORN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUANGSMORN
Middle Name:
Last Name:STAPATYANON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N RAMPART ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-1854
Mailing Address - Country:US
Mailing Address - Phone:714-704-4545
Mailing Address - Fax:
Practice Address - Street 1:301 N RAMPART ST
Practice Address - Street 2:SUITE E
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-1854
Practice Address - Country:US
Practice Address - Phone:714-704-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 16951103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical