Provider Demographics
NPI:1093735599
Name:PAZAK, SUSAN (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:PAZAK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 SENTINEL PL
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3331
Mailing Address - Country:US
Mailing Address - Phone:949-363-0700
Mailing Address - Fax:949-643-0114
Practice Address - Street 1:30131 TOWN CENTER DR
Practice Address - Street 2:SUITE 280
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2034
Practice Address - Country:US
Practice Address - Phone:949-363-0700
Practice Address - Fax:949-643-0114
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17583103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP17583Medicare ID - Type Unspecified