Provider Demographics
NPI:1649357021
Name:HARTUNIAN, SUSAN LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LYNN
Last Name:HARTUNIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7793
Mailing Address - Street 2:
Mailing Address - City:CAPISTRANO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92624-7793
Mailing Address - Country:US
Mailing Address - Phone:949-769-0309
Mailing Address - Fax:949-443-1434
Practice Address - Street 1:510 SUPERIOR AVE
Practice Address - Street 2:SUITE 200-G
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3663
Practice Address - Country:US
Practice Address - Phone:949-769-0309
Practice Address - Fax:949-443-1434
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG63737208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G637370OtherMEDICAL
CAF57104Medicare UPIN