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Individual

SUSAN EZRA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
130 GREENFIELD AVE, SAN ANSELMO, CA 94960-2449
(415) 308-7808
Mailing address
80 TAYLOR DR, FAIRFAX, CA 94930-1237
(415) 308-7808

Taxonomy

Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
263906
CA

Other

Enumeration date
10/01/2009
Last updated
10/01/2009
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