MEDICARE: GABRIELLE SUAREZ MS, CNIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1164092409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE SUAREZ MS, CNIM

Provider Business Mailing Address
First Line	:	3455 KEARNY VILLA RD APT 224
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1977
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3455 KEARNY VILLA RD APT 224
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1977
Country	:	US
Telephone Number	:	209-879-3612
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2021
Last Update Date	:	06/29/2021

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