Healthcare Provider Details

I. General information

NPI: 1841074267
Provider Name (Legal Business Name): LA SUAREZ A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S 5TH ST STE B
BRAWLEY CA
92227-2408
US

IV. Provider business mailing address

125 S 5TH ST STE B
BRAWLEY CA
92227-2408
US

V. Phone/Fax

Practice location:
  • Phone: 760-344-8100
  • Fax: 760-545-0243
Mailing address:
  • Phone: 760-344-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LORENZO SUAREZ
Title or Position: PRESIDENT
Credential: MD
Phone: 760-498-4407