Active NPI
Susan Douglas, M.D.
- Neurology Physician
- Rancho Palos Verdes, CA
National Provider Identifier
1053610824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- A052062
- Practice address
- 21 Via San Remo
Rancho Palos Verdes, CA 90275-5374 - Phone
- (310) 701-2155
- NPI assigned
- Mar 19, 2011
- Last updated
- Mar 19, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | A052062 | CA | Primary |
Addresses
Primary practice location
21 Via San Remo
Rancho Palos Verdes, CA 90275-5374
Mailing address
21 Via San Remo
Rancho Palos Verdes, CA 90275-5374
Phone (310) 701-2155
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A052062 | CA | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1300492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1300492800000",
"number": "1053610824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 VIA SAN REMO",
"city": "RANCHO PALOS VERDES",
"state": "CA",
"postal_code": "902755374",
"telephone_number": "310-701-2155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 VIA SAN REMO",
"city": "RANCHO PALOS VERDES",
"state": "CA",
"postal_code": "902755374",
"telephone_number": "310-701-2155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGLAS",
"first_name": "SUSAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-03-19",
"last_updated": "2011-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "CA",
"license": "A052062",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rancho Palos Verdes, CA
- Diego Medical Corporation
- Mary L. Dimyan, D.D.S.
- Discovery Practice Management, Inc (Center For Discovery, Rancho Palos Verdes)
- Divine Wellness Spa
- Doctor Zo DC
- Susan G. Dragoo, RDHAP
- David Bruce Draper, MFT, PSYD
- Dynamic Physical Medicine Inc.
- Marie Louise Earvolino-Ramirez, NP
- Elite Senior Services, Inc. (The Senior Shuttle)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.