Healthcare Provider Details

I. General information

NPI: 1104747435
Provider Name (Legal Business Name): ELIZABETH ALINA SUAREZ CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13563 HEACOCK ST
MORENO VALLEY CA
92553-3300
US

IV. Provider business mailing address

13563 HEACOCK ST
MORENO VALLEY CA
92553-3300
US

V. Phone/Fax

Practice location:
  • Phone: 951-571-4560
  • Fax:
Mailing address:
  • Phone: 951-571-4560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number35536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: