1932200607 NPI number — DR. SUZANNE GERE PH. D.

Table of content: DR. SUZANNE GERE PH. D. (NPI 1932200607)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932200607 NPI number — DR. SUZANNE GERE PH. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GERE
Provider First Name:
SUZANNE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH. D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932200607
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1252 RUBENSTEIN AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARDIFF
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-815-8585
Provider Business Mailing Address Fax Number:
760-230-1074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2382 FARADAY AVE
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92008-7218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-815-8585
Provider Business Practice Location Address Fax Number:
760-230-1074
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY 15773 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1297731 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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