Provider Demographics
NPI:1588170385
Name:BELL, SUSAN (CLEC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:BELL
Suffix:
Gender:F
Credentials:CLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1754 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-4335
Mailing Address - Country:US
Mailing Address - Phone:1415-793-0580
Mailing Address - Fax:
Practice Address - Street 1:1754 25TH AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-4335
Practice Address - Country:US
Practice Address - Phone:1415-793-0580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-17
Last Update Date:2017-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN