Healthcare Provider Details

I. General information

NPI: 1497061642
Provider Name (Legal Business Name): MICHELLE JOSEPHINE SUAREZ NEWBREY RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 W AVENUE J STE G
LANCASTER CA
93534-3685
US

IV. Provider business mailing address

24 HAMMOND STE C
IRVINE CA
92618-1680
US

V. Phone/Fax

Practice location:
  • Phone: 661-945-0884
  • Fax: 661-942-9714
Mailing address:
  • Phone: 949-521-6658
  • Fax: 800-924-7223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17904
License Number StateZZ
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8839
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number36762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: