1285758433 NPI number — MRS. SUSAN MATHISON MORRISON M.D.

Table of content: MRS. SUSAN MATHISON MORRISON M.D. (NPI 1285758433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285758433 NPI number — MRS. SUSAN MATHISON MORRISON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORRISON
Provider First Name:
SUSAN
Provider Middle Name:
MATHISON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COHEN
Provider Other First Name:
SUSAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285758433
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6310 SAN VICENTE BLVD STE 330
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90048-5471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-933-6330
Provider Business Mailing Address Fax Number:
323-933-6334

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6310 SAN VICENTE BLVD STE 330
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90048-5471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-933-6330
Provider Business Practice Location Address Fax Number:
323-933-6334
Provider Enumeration Date:
03/16/2007

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: 207V00000X , with the licence number:  A62028 , 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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