Provider Demographics
NPI:1285650382
Name:SWEENEY, SUSAN E (MD PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 GILMAN DR-0656
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0656
Mailing Address - Country:US
Mailing Address - Phone:858-534-2359
Mailing Address - Fax:858-534-2606
Practice Address - Street 1:9500 GILMAN DR #0656
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0656
Practice Address - Country:US
Practice Address - Phone:858-534-2359
Practice Address - Fax:858-534-2606
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81194207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A811940Medicaid
CAI26923Medicare UPIN
CA00A811940Medicaid