Individual
MARK D SUSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2166 N MOORPARK ROAD, SUITE 102, THOUSAND OAKS, CA 91360-5009
(805) 494-3330
(805) 494-1255
Mailing address
227 W JANSS RD STE 320, THOUSAND OAKS, CA 91360-1870
(805) 494-3330
(805) 494-1255
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
G76464
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G764640
—
CA
01
—
2086S0122X
TAXONOMY
CA
Enumeration date
11/13/2006
Last updated
12/18/2020
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