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General NPI Number Information
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NPI Number | 1427277144
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Entity Type | Individual
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Provider Name | EDGARDO CARLOS SUAREZ D.C.
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Gender | Male
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3838 JACKSON ST STE A
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City | RIVERSIDE
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State | CA
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Zip | 92503-3917
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Country | US
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Telephone | 951-637-7546
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Fax | 951-637-2393
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Provider Business Mailing Address
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Address Line | 36074 MUSTANG SPIRIT LN
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City | WILDOMAR
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State | CA
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Zip | 92595-7603
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Country | US
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Telephone | 951-264-3668
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Fax | 951-637-2393
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 29391
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License Number State | CA
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