Provider Demographics
NPI:1760450936
Name:PEJORO, SUSAN IRENE (NP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:IRENE
Last Name:PEJORO
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Gender:F
Credentials:NP
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Mailing Address - Street 1:2101 ADMIRALTY LN
Mailing Address - Street 2:SCI, #128
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1624
Mailing Address - Country:US
Mailing Address - Phone:650-493-5000
Mailing Address - Fax:650-849-0131
Practice Address - Street 1:3801 MIRANDA AVE
Practice Address - Street 2:VAPAHCS, SCI #128
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:650-849-0131
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CANP 10092363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology