Provider Demographics
NPI:1750521084
Name:TENNIS, SUZANNE (RD, DRHSC)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:TENNIS
Suffix:
Gender:F
Credentials:RD, DRHSC
Other - Prefix:DR
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:TENNIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, DRHSC
Mailing Address - Street 1:790 LAUREL ST
Mailing Address - Street 2:#110
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-3164
Mailing Address - Country:US
Mailing Address - Phone:650-637-0480
Mailing Address - Fax:
Practice Address - Street 1:790 LAUREL ST
Practice Address - Street 2:#110
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3164
Practice Address - Country:US
Practice Address - Phone:650-637-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA622712133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered