Provider Demographics
NPI:1962862870
Name:WARD, SUSAN J (MS, NUTRITION)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:WARD
Suffix:
Gender:F
Credentials:MS, NUTRITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 WASHINGTON ST
Mailing Address - Street 2:246
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2110
Mailing Address - Country:US
Mailing Address - Phone:310-367-8045
Mailing Address - Fax:
Practice Address - Street 1:1122 W BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1414
Practice Address - Country:US
Practice Address - Phone:818-736-9889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist