MEDICARE: MR. JOSE LUIS SUAREZ JR. P.A.

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	363AM0700X	Medical Physician Assistant	PA17072	CA

General Provider Information

NPI Number	:	1497757728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSE LUIS SUAREZ JR. P.A.

Provider Business Mailing Address
First Line	:	969 S SANTA FE AVE STE A
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92083-6910
Country	:	US
Telephone Number	:	760-941-7050
Fax Number	:	760-941-7142

Provider Business Practice Location Address
First Line	:	969 S SANTA FE AVE STE A
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92083-6910
Country	:	US
Telephone Number	:	760-941-7050
Fax Number	:	760-941-7250

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	12/11/2019

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