Provider Demographics
NPI:1790952844
Name:KHAMBATA, SUZANNE (FNP)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:KHAMBATA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 MESA COLLEGE DR # L-504
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-4902
Mailing Address - Country:US
Mailing Address - Phone:619-388-2774
Mailing Address - Fax:619-388-2853
Practice Address - Street 1:7250 MESA COLLEGE DR # L-504
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-4902
Practice Address - Country:US
Practice Address - Phone:619-388-2774
Practice Address - Fax:619-388-2853
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8165364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health