Provider Demographics
NPI:1972251254
Name:IAZZETTA, SUZANNE PATRICE
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:PATRICE
Last Name:IAZZETTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 E 2ND ST UNIT 203
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5112
Mailing Address - Country:US
Mailing Address - Phone:973-913-4693
Mailing Address - Fax:
Practice Address - Street 1:2101 E 2ND ST UNIT 203
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5112
Practice Address - Country:US
Practice Address - Phone:973-913-4693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program