Provider Demographics
NPI:1427129741
Name:MANCHERIAN, SUZANNE LEE (DPM)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:LEE
Last Name:MANCHERIAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:585 S FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-2035
Mailing Address - Country:US
Mailing Address - Phone:323-937-6903
Mailing Address - Fax:323-937-2035
Practice Address - Street 1:6200 WILSHIRE BLVD STE 1712
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:323-937-6903
Practice Address - Fax:323-210-7171
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4429213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U91307Medicare UPIN
CAE4429Medicare ID - Type Unspecified
CA6099760001Medicare NSC