Healthcare Provider Details

I. General information

NPI: 1376234047
Provider Name (Legal Business Name): MARCOS SUAREZ CSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 W 100 N STE 110
PROVIDENCE UT
84332-9826
US

IV. Provider business mailing address

500 S 11TH AVE STE 400
POCATELLO ID
83201-4880
US

V. Phone/Fax

Practice location:
  • Phone: 435-755-6075
  • Fax:
Mailing address:
  • Phone: 208-232-7862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13398245-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: