Provider Demographics
NPI:1851334585
Name:SKLAR, SUSAN ETTA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ETTA
Last Name:SKLAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 E SPRING ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1270
Mailing Address - Country:US
Mailing Address - Phone:562-596-5196
Mailing Address - Fax:562-252-9505
Practice Address - Street 1:5000 E SPRING ST
Practice Address - Street 2:SUITE 402
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1270
Practice Address - Country:US
Practice Address - Phone:562-596-5196
Practice Address - Fax:562-252-9505
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46856207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G46856Medicare ID - Type Unspecified