Provider Demographics
NPI:1013287119
Name:DAVOODIFAR, SUSAN (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:DAVOODIFAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4199 CAMPUS DR
Mailing Address - Street 2:SUITE 550
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-4684
Mailing Address - Country:US
Mailing Address - Phone:949-509-6503
Mailing Address - Fax:949-326-0103
Practice Address - Street 1:4199 CAMPUS DR
Practice Address - Street 2:SUITE 550
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-4684
Practice Address - Country:US
Practice Address - Phone:949-509-6503
Practice Address - Fax:949-326-0103
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62141207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine