Healthcare Provider Details

I. General information

NPI: 1548822349
Provider Name (Legal Business Name): MARA BERNAL SUAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 CALIFORNIA ST RM 801
SAN FRANCISCO CA
94118-1510
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-5400
  • Fax: 415-369-1294
Mailing address:
  • Phone: 415-600-5400
  • Fax: 415-369-1294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95015202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: