Provider Demographics
NPI:1760893739
Name:PIPKIN, SUZANNE (LAC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:PIPKIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4833 BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-2517
Mailing Address - Country:US
Mailing Address - Phone:619-787-4353
Mailing Address - Fax:
Practice Address - Street 1:1804 CABLE ST STE B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-3141
Practice Address - Country:US
Practice Address - Phone:619-787-4353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16112171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist