1861886814 NPI number — DR. YELIZAVETA BAYKINA SUSLOW AU.D.

Table of content: JOSHUA DANIEL WHICKER IDC (NPI 1316331564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861886814 NPI number — DR. YELIZAVETA BAYKINA SUSLOW AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUSLOW
Provider First Name:
YELIZAVETA
Provider Middle Name:
BAYKINA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAYKINA
Provider Other First Name:
YELIZAVETA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861886814
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31 PANORAMIC WAY FL 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94595-1627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-938-8686
Provider Business Mailing Address Fax Number:
925-938-7473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 FRANKLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94109-5426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-931-8180
Provider Business Practice Location Address Fax Number:
415-931-1323
Provider Enumeration Date:
03/26/2015

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: 237600000X , with the licence number:  3035 , 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)





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