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General NPI Number Information
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NPI Number | 1487941340
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Entity Type | Individual
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Provider Name | DR. MARISSA FAELDAN-SUAREZ
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Gender | Female
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Dates
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Enumeration Date | 06/29/2011
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Last Update Date | 04/19/2013
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Provider Practice Location Address
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Address Line | 1827 GREENFIELD AVE APT 105
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City | LOS ANGELES
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State | CA
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Zip | 90025-4409
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Country | US
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Telephone | 626-379-1110
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Fax |
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Provider Business Mailing Address
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Address Line | 16018 AMAR RD
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City | CITY OF INDUSTRY
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State | CA
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Zip | 91744-2203
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Country | US
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Telephone | 626-968-7525
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 58944
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License Number State | CA
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