Healthcare Provider Details

I. General information

NPI: 1801713367
Provider Name (Legal Business Name): PRIME HEALTH MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3214 HONOLULU AVE
LA CRESCENTA CA
91214-3327
US

IV. Provider business mailing address

3214 HONOLULU AVE
LA CRESCENTA CA
91214-3327
US

V. Phone/Fax

Practice location:
  • Phone: 818-369-7022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: EZEQUIEL SUAREZ
Title or Position: CEO/ OWNER
Credential: MD
Phone: 818-369-7022