Healthcare Provider Details

I. General information

NPI: 1972749372
Provider Name (Legal Business Name): MERTON SUZUKI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12630 MONTE VISTA RD SUITE 108
POWAY CA
92064-2530
US

IV. Provider business mailing address

12630 MONTE VISTA RD STE 108
POWAY CA
92064-2526
US

V. Phone/Fax

Practice location:
  • Phone: 858-487-6860
  • Fax: 858-487-4166
Mailing address:
  • Phone: 858-487-6860
  • Fax: 858-487-4166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberG21638
License Number StateCA

VIII. Authorized Official

Name: DR. MERTON SUZUKI
Title or Position: PRESIDENT
Credential: MD
Phone: 858-487-6860