Basic Information
| Provider Information | |||||||||
| NPI: | 1184162562 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUSON | ||||||||
| FirstName: | RACHEL ROSE | ||||||||
| MiddleName: | MERCADO | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1880 S RIMPAU BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900195629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105930119 | ||||||||
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| Practice Location | |||||||||
| Address1: | 427 WILSHIRE BLVD | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904011409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106568600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2017 | ||||||||
| LastUpdateDate: | 02/06/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 292796 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.