Provider Demographics
NPI:1366412363
Name:RIBEIRO, SUSAN DIANNE (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DIANNE
Last Name:RIBEIRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:DIANNE
Other - Last Name:GUTHRIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18653 WEDGE PARKWAY, SUITE 130
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511
Mailing Address - Country:US
Mailing Address - Phone:775-770-7630
Mailing Address - Fax:775-770-7635
Practice Address - Street 1:18653 WEDGE PARKWAY, SUITE 130
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511
Practice Address - Country:US
Practice Address - Phone:775-770-7630
Practice Address - Fax:775-770-7635
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9124208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV3102343Medicaid
NV3102343Medicaid
NV3102343Medicaid