Provider Demographics
NPI:1801088117
Name:SUSAN E SPRAU MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SUSAN E SPRAU MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-453-3989
Mailing Address - Street 1:PO BOX 280655
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91328-0655
Mailing Address - Country:US
Mailing Address - Phone:310-453-3989
Mailing Address - Fax:310-453-2154
Practice Address - Street 1:200 UCLA MEDICAL PLZ
Practice Address - Street 2:SUITE B265-29
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-8344
Practice Address - Country:US
Practice Address - Phone:310-453-3989
Practice Address - Fax:310-453-2154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44652207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G446520Medicaid
1801088117OtherNPI
CA1265469894OtherNPI
CA1992788426OtherNPI
CA00G446520Medicaid