SUSANA JUDITH PRAVER PAC NPI 1255434452

NPI Information

NPI: 1255434452
Provider Name: SUSANA JUDITH PRAVER, PAC
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

PECOS Registration: Yes

Address:
3451 E 12TH ST
OAKLAND, CA
ZIP 94601
Phone: (510) 535-3317
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Susana Judith Praver, PAC is a medical physician assistant in Oakland, CA. Susana Judith Praver, PAC NPI is 1255434452. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3451 E 12TH ST
OAKLAND, CA
ZIP 94601
Phone: (510) 535-3317
Fax: (510) 535-4248

The NPI 1255434452 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/6/2006 and was last updated on 8/6/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	PA10842	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	ZZZ29799Z	OTHER	CALIFORNIA	FQHC MEDICARE PART B
2	HAP72021F	OTHER	CALIFORNIA	FPACT
3	55-1975	OTHER	CALIFORNIA	FQHC MEDICARE PART A
4	FHC71021F	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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