Doctor Name: | SUSANNE M POWELL |
NPI Number: | 1275584500 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | A44941 |
Business Practice Address: | 1712 Picasso Ave #c Davis, CA - 956160546 |
Business Phone Number: | 5307503500 |
Business Fax Number: | 5307503500 |
Mailing Address: | 1756 Picasso Ave E, DAVIS |
State: | CA |
Postal Code: | 956180549 |
Phone Number: | 5307503500 |
Fax Number: | 5307503045 |
NPI Enumeration Date: | 05/12/2006 |
NPI Last Update Date: | 10/01/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | A44941 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |