Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | ND1052 | CA |
NPI | 1144853995 |
---|---|
Provider Name | Marda Sussman |
First Address | Newport Beach, CA 92660-9025 |
Second Address | Costa Mesa, CA 92626-4627 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2020 |
Last Update Date | 20/02/2020 |