Provider Demographics
NPI:1477213221
Name:SUOZZI, MELANIE JULIA HEERS
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:JULIA HEERS
Last Name:SUOZZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3151 CROW CANYON PL
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1359
Mailing Address - Country:US
Mailing Address - Phone:925-202-0340
Mailing Address - Fax:
Practice Address - Street 1:3151 CROW CANYON PL
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1359
Practice Address - Country:US
Practice Address - Phone:925-202-0341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016599363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily