Provider Demographics
NPI:1780688036
Name:LANSANGAN, SUSANNA D (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSANNA
Middle Name:D
Last Name:LANSANGAN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:777 FLOWER ST
Mailing Address - Street 2:STE A
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-3000
Mailing Address - Country:US
Mailing Address - Phone:818-637-2000
Mailing Address - Fax:818-242-8761
Practice Address - Street 1:191 S BUENA VISTA ST
Practice Address - Street 2:STE. 200
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4554
Practice Address - Country:US
Practice Address - Phone:818-557-2671
Practice Address - Fax:818-557-0761
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2011-04-14
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Provider Licenses
StateLicense IDTaxonomies
CAA52671207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A526710Medicaid
CA00A526710Medicaid
CAWA52671DMedicare PIN