Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A142141 | CA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | A142141 | CA |
NPI | 1235558875 |
---|---|
Provider Name | Susan Behnawa |
First Address | Temecula, CA 92590-5528 |
Second Address | Menifee, CA 92586-5505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2014 |
Last Update Date | 14/02/2020 |