Provider Demographics
NPI:1922123355
Name:GIEZENTANER, SUSANNAH PAZDRAL (DO)
Entity Type:Individual
Prefix:DR
First Name:SUSANNAH
Middle Name:PAZDRAL
Last Name:GIEZENTANER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:SUSANNAH
Other - Middle Name:L
Other - Last Name:PAZDRAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1630 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-5204
Mailing Address - Country:US
Mailing Address - Phone:619-590-4230
Mailing Address - Fax:619-590-4325
Practice Address - Street 1:1630 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5204
Practice Address - Country:US
Practice Address - Phone:619-590-4230
Practice Address - Fax:619-590-4325
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine