Provider Demographics
NPI:1265572499
Name:DANEK, SUSAN MARY (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARY
Last Name:DANEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:MARY
Other - Last Name:TAFOYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:29798 HAUN RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-6541
Mailing Address - Country:US
Mailing Address - Phone:951-301-7191
Mailing Address - Fax:951-301-4160
Practice Address - Street 1:29798 HAUN RD
Practice Address - Street 2:SUITE 302
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-6541
Practice Address - Country:US
Practice Address - Phone:951-301-7191
Practice Address - Fax:951-301-4160
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG080713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG80713Medicare UPIN