Provider Demographics
NPI:1518572791
Name:AN, SUSIE
Entity type:Individual
Prefix:
First Name:SUSIE
Middle Name:
Last Name:AN
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 1:12555 EUCLID ST APT 35
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-5265
Mailing Address - Country:US
Mailing Address - Phone:310-954-9597
Mailing Address - Fax:310-861-8882
Practice Address - Street 1:12555 EUCLID ST APT 35
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5265
Practice Address - Country:US
Practice Address - Phone:310-954-9597
Practice Address - Fax:310-861-8882
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care