Individual
SUJA SAMUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
597 CENTER AVENUE, SUITE 200-A, MARTINEZ, CA 94553
(925) 313-6740
Mailing address
P.O.BOX 4738, ANTIOCH, CA 94531
(405) 436-3557
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
666581
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F3305375
DRIVER'S LICENSE
CA
Enumeration date
10/23/2015
Last updated
10/23/2015
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