Basic Information
| Provider Information | |||||||||
| NPI: | 1598884306 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PALENDECH | ||||||||
| FirstName: | SUSAN | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 EUCALYPTUS DR | ||||||||
| Address2: | |||||||||
| City: | EL SEGUNDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902453839 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 13160 MINDANAO WAY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MARINA DEL REY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902926358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108543800 | ||||||||
| FaxNumber: | 3108543820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 410472 | CA | X | Nursing Service Providers | Registered Nurse | 363L00000X | 10134 | CA | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 10134 | 01 | CA | NP LICENSE | OTHER | 410472 | 01 | CA | RN LICENSE | OTHER |