Doctor Name: | MRS. SUSANA FAVILA |
NPI Number: | 1447679790 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | F0414053 |
Business Practice Address: | 667 Yucca St Imperial, CA - 922518925 |
Business Phone Number: | 7605548180 |
Business Fax Number: | |
Mailing Address: | 667 Yucca St., IMPERIAL |
State: | CA |
Postal Code: | 92251 |
Phone Number: | 7605548180 |
Fax Number: | |
NPI Enumeration Date: | 04/15/2014 |
NPI Last Update Date: | 04/15/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | F0414053 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |