Healthcare Provider Details

I. General information

NPI: 1003095258
Provider Name (Legal Business Name): LEAH L SUAREZ-ABRAHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAH L ABRAHAM MD

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E BEACH ST
WATSONVILLE CA
95076-4809
US

IV. Provider business mailing address

14 LAKE ST
OAK PARK IL
60302-2606
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-0222
  • Fax: 831-707-2777
Mailing address:
  • Phone: 708-383-0113
  • Fax: 708-383-9911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036109014
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: