Provider Demographics
NPI:1851958680
Name:BRONSTEIN, SUSAN J (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:J
Last Name:BRONSTEIN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 16TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-3801
Mailing Address - Country:US
Mailing Address - Phone:310-450-8338
Mailing Address - Fax:310-396-6149
Practice Address - Street 1:1651 16TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3801
Practice Address - Country:US
Practice Address - Phone:310-450-8338
Practice Address - Fax:310-396-6149
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347882163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool