Provider Demographics
NPI:1427112242
Name:FALKENBURG, SUZANNE MARY (RD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARY
Last Name:FALKENBURG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 CLARK AVE
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2618
Mailing Address - Country:US
Mailing Address - Phone:562-804-7444
Mailing Address - Fax:562-804-7009
Practice Address - Street 1:5220 CLARK AVE
Practice Address - Street 2:SUITE 100B
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2618
Practice Address - Country:US
Practice Address - Phone:562-804-7444
Practice Address - Fax:562-804-7009
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered