Provider Demographics
NPI:1992087795
Name:CZUCHRA, SUSANNA ELIZABETH (LAC)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:ELIZABETH
Last Name:CZUCHRA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 MILLER AVENUE, STE C
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941
Mailing Address - Country:US
Mailing Address - Phone:415-271-2171
Mailing Address - Fax:415-383-4465
Practice Address - Street 1:295 MILLER AVENUE, STE C
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941
Practice Address - Country:US
Practice Address - Phone:415-271-2171
Practice Address - Fax:415-383-4465
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 7057171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist