Healthcare Provider Details

I. General information

NPI: 1467108860
Provider Name (Legal Business Name): JESUS F SUAREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 CENTER AVE STE 160
RANCHO CUCAMONGA CA
91730-5838
US

IV. Provider business mailing address

2726 S DESERT FOREST AVE
ONTARIO CA
91761-7412
US

V. Phone/Fax

Practice location:
  • Phone: 858-264-5858
  • Fax:
Mailing address:
  • Phone: 909-704-5882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2831633
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: