Provider Demographics
NPI:1154802510
Name:FOSTER, SUZETTE CHANEL
Entity type:Individual
Prefix:MS
First Name:SUZETTE
Middle Name:CHANEL
Last Name:FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 PARKMOOR AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-3798
Mailing Address - Country:US
Mailing Address - Phone:408-961-9850
Mailing Address - Fax:408-961-9856
Practice Address - Street 1:1400 PARKMOOR AVE STE 230
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-3798
Practice Address - Country:US
Practice Address - Phone:408-961-9850
Practice Address - Fax:408-961-9856
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator