Provider Demographics
NPI:1023633419
Name:MIN, SUSAN
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:MIN
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 1:325 PALOS VERDES BLVD APT 5B
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-6316
Mailing Address - Country:US
Mailing Address - Phone:909-217-6417
Mailing Address - Fax:
Practice Address - Street 1:16314 CORNUTA AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-4814
Practice Address - Country:US
Practice Address - Phone:562-461-9272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician