Healthcare Provider Details

I. General information

NPI: 1124733043
Provider Name (Legal Business Name): ASHLYNN JANELLE SUQUETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 01/16/2023
Certification Date: 01/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N HILL AVE STE 100
PASADENA CA
91106-1949
US

IV. Provider business mailing address

963 N LYMAN AVE
COVINA CA
91724-2262
US

V. Phone/Fax

Practice location:
  • Phone: 657-242-2079
  • Fax:
Mailing address:
  • Phone: 626-235-9260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: