Healthcare Provider Details

I. General information

NPI: 1275590028
Provider Name (Legal Business Name): ANGELI D SUAREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 WARNER AVE STE 368
FOUNTAIN VALLEY CA
92708-7514
US

IV. Provider business mailing address

11122 RANGER DR
LOS ALAMITOS CA
90720-2649
US

V. Phone/Fax

Practice location:
  • Phone: 714-241-1777
  • Fax:
Mailing address:
  • Phone: 270-836-1737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number29114
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC148727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: