Provider Demographics
NPI:1891822045
Name:SALZWEDEL, SUSAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:SALZWEDEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 845996
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-5996
Mailing Address - Country:US
Mailing Address - Phone:858-888-7700
Mailing Address - Fax:858-221-5014
Practice Address - Street 1:5522 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91411-3437
Practice Address - Country:US
Practice Address - Phone:818-990-5020
Practice Address - Fax:818-990-8549
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14060207Q00000X, 363AS0400X
CANP014060363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP014060OtherMEDICAL LICENSE
13578042OtherCAQH
13578042OtherCAQH