Provider Demographics
NPI:1942054119
Name:DAVIN HANCOCK, SUSAN MARIE (RTCRT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:DAVIN HANCOCK
Suffix:
Gender:F
Credentials:RTCRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 RENZ RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CA
Mailing Address - Zip Code:95938-9627
Mailing Address - Country:US
Mailing Address - Phone:530-895-8731
Mailing Address - Fax:
Practice Address - Street 1:2095 RENZ RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:CA
Practice Address - Zip Code:95938-9627
Practice Address - Country:US
Practice Address - Phone:530-895-3178
Practice Address - Fax:530-895-8731
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHN000403872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology