MEDICARE: KAITLYN SUHA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1295230555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN SUHA

Provider Business Mailing Address
First Line	:	1650 SPRUCE ST
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-7402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 SPRUCE ST
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-7402
Country	:	US
Telephone Number	:	760-634-1125
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2018
Last Update Date	:	03/28/2018

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Directions to “ KAITLYN SUHA ” Practice Location

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