Provider Demographics
NPI:1285082859
Name:SUISSA, DANIEL (MD, MSC, FRCSC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:SUISSA
Suffix:
Gender:M
Credentials:MD, MSC, FRCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 S BEVERLY DR STE 990
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4801
Mailing Address - Country:US
Mailing Address - Phone:310-409-4422
Mailing Address - Fax:
Practice Address - Street 1:9201 W SUNSET BLVD STE 708
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3708
Practice Address - Country:US
Practice Address - Phone:424-285-5545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1423462086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery