Provider Demographics
NPI:1528728060
Name:NEVAREZ, SUSANNAH (MT-BC)
Entity type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:
Last Name:NEVAREZ
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-4821
Mailing Address - Country:US
Mailing Address - Phone:310-465-5160
Mailing Address - Fax:
Practice Address - Street 1:1015 AVENUE B
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-4821
Practice Address - Country:US
Practice Address - Phone:310-465-5160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-24
Last Update Date:2021-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty