Provider Demographics
NPI:1942780002
Name:SPITZ, MA SUSANA ECHEVERRIA (AGPCNP)
Entity Type:Individual
Prefix:MS
First Name:MA SUSANA
Middle Name:ECHEVERRIA
Last Name:SPITZ
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 GOLDEN RAIN RD
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-4907
Mailing Address - Country:US
Mailing Address - Phone:562-493-9581
Mailing Address - Fax:562-795-6397
Practice Address - Street 1:24122 ALLIENE AVE
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-1013
Practice Address - Country:US
Practice Address - Phone:213-219-2595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009449363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$OtherADULT GERONTOLOGY PRIMARY CARE NURSE PRACTITIONER