Provider Demographics
NPI:1871661165
Name:UNGAR, SUSAN MARIE (MS,NP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:UNGAR
Suffix:
Gender:F
Credentials:MS,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2680
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95001-2680
Mailing Address - Country:US
Mailing Address - Phone:831-818-5357
Mailing Address - Fax:831-325-0165
Practice Address - Street 1:4841 SOQUEL DR
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2428
Practice Address - Country:US
Practice Address - Phone:831-818-5357
Practice Address - Fax:831-325-0165
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA309539363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health