Healthcare Provider Details

I. General information

NPI: 1467160929
Provider Name (Legal Business Name): MARIANO RICARDO SURIEL PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARIANO RICARDO SURIEL GUERRERO

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2395 LOMBARD ST
SAN FRANCISCO CA
94123-2601
US

IV. Provider business mailing address

75 FRANCIS ST
BOSTON MA
02115-6106
US

V. Phone/Fax

Practice location:
  • Phone: 415-796-2242
  • Fax:
Mailing address:
  • Phone: 617-732-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9145
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA68471
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: