Basic Information
| Provider Information | |||||||||
| NPI: | 1568495042 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERTSCH | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | EVELYN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 DISTEL CIR | ||||||||
| Address2: | |||||||||
| City: | LOS ALTOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940221408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6506528500 | ||||||||
| FaxNumber: | 4083285695 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 TROUSDALE DR | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | BURLINGAME | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940104506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6506528515 | ||||||||
| FaxNumber: | 6506528502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 06/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0002X | G64384 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | 207R00000X | G64384 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.