Healthcare Provider Details

I. General information

NPI: 1821278904
Provider Name (Legal Business Name): ZORAIDA SUAREZ,MD A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5363 BALBOA BLVD SUITE 433
ENCINO CA
91316-2805
US

IV. Provider business mailing address

5363 BALBOA BLVD SUITE 433
ENCINO CA
91316-2805
US

V. Phone/Fax

Practice location:
  • Phone: 818-788-8838
  • Fax: 818-788-0851
Mailing address:
  • Phone: 818-788-8838
  • Fax: 818-788-0851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA42275
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA42275
License Number StateCA

VIII. Authorized Official

Name: DR. ZORAIDA SUAREZ
Title or Position: CEO
Credential: M.D.
Phone: 818-788-8838