Provider Demographics
NPI:1811008295
Name:SPRAU, SUSAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:SPRAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 280655
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91328-0655
Mailing Address - Country:US
Mailing Address - Phone:310-453-3989
Mailing Address - Fax:310-453-2154
Practice Address - Street 1:200 UCLA MEDICAL PLZ
Practice Address - Street 2:SUITE B265-29
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-8344
Practice Address - Country:US
Practice Address - Phone:310-453-3989
Practice Address - Fax:310-453-2154
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG44652207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G446520Medicaid
CA1811008295OtherNPI
CA00G446520Medicaid
CAA92506Medicare UPIN