Provider Demographics
NPI:1992892293
Name:MCNULTY, SUZANNE LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:LYNN
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:26161 LA PAZ RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5317
Mailing Address - Country:US
Mailing Address - Phone:949-206-0001
Mailing Address - Fax:949-206-0011
Practice Address - Street 1:26161 LA PAZ RD
Practice Address - Street 2:SUITE 115
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5317
Practice Address - Country:US
Practice Address - Phone:949-206-0001
Practice Address - Fax:949-206-0011
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA74237208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics