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General NPI Number Information
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NPI Number | 1851704142
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Entity Type | Individual
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Provider Name | LYNNETTE SUAREZ
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Gender | Female
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Dates
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Enumeration Date | 06/04/2014
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Last Update Date | 05/06/2021
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Provider Practice Location Address
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Address Line | 789 EASTON AVE 2
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City | SAN BRUNO
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State | CA
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Zip | 94066-3563
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Country | US
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Telephone | 650-922-5433
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 381
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City | LAVEEN
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State | AZ
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Zip | 85339
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Country | US
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Telephone |
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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 | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number |
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License Number State |
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