Healthcare Provider Details

I. General information

NPI: 1396388054
Provider Name (Legal Business Name): DANIEL SUALES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 INDUSTRY WAY
LYNWOOD CA
90262-4284
US

IV. Provider business mailing address

2640 INDUSTRY WAY
LYNWOOD CA
90262-4284
US

V. Phone/Fax

Practice location:
  • Phone: 310-627-4525
  • Fax:
Mailing address:
  • Phone: 310-627-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number139656
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: