Provider Demographics
NPI:1851334585
Name:SKLAR, SUSAN ETTA (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ETTA
Last Name:SKLAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 E 2ND ST STE 403
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5324
Mailing Address - Country:US
Mailing Address - Phone:562-245-9027
Mailing Address - Fax:562-330-1908
Practice Address - Street 1:2999 E OCEAN BLVD UNIT 1130
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-8214
Practice Address - Country:US
Practice Address - Phone:562-245-9027
Practice Address - Fax:562-330-1908
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46856207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G46856Medicare ID - Type Unspecified