Provider Demographics
NPI:1700987369
Name:HOPKINS, SUSAN MILDRED (MD)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:MILDRED
Last Name:HOPKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:18433 ROSCOE BLVD
Mailing Address - Street 2:#102
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325
Mailing Address - Country:US
Mailing Address - Phone:818-709-6700
Mailing Address - Fax:818-709-6707
Practice Address - Street 1:18433 ROSCOE BLVD
Practice Address - Street 2:#102
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325
Practice Address - Country:US
Practice Address - Phone:818-709-6700
Practice Address - Fax:818-709-6707
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG079146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0061720Medicaid
CAG04269Medicare UPIN
CAGR0061720Medicaid