Individual
SUSANA LIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
25400 ALESSANDRO BLVD # 3105, MORENO VALLEY, CA 92553-4319
(951) 570-0043
Mailing address
4797 CHICAGO AVE, RIVERSIDE, CA 92507-5814
(951) 776-7080
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
—
—
Other
Enumeration date
04/19/2022
Last updated
04/19/2022
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