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NPI Code Detail

MEDICARE: CHANUWAT M. SUNTALUS PA-C

MEDICARE: CHANUWAT M. SUNTALUS PA-C
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
1363A00000XPhysician AssistantPA17843CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518158047
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANUWAT M. SUNTALUS PA-C
Provider Business Mailing Address
First Line : 1601 MONTE VISTA AVE STE 190
Second Line :
City : CLAREMONT
State : CA
Zip : 91711-6600
Country : US
Telephone Number : 626-617-9166
Fax Number : 909-469-2119
Provider Business Practice Location Address
First Line : 1601 MONTE VISTA AVE STE 190
Second Line :
City : CLAREMONT
State : CA
Zip : 91711-6600
Country : US
Telephone Number : 909-865-9977
Fax Number : 909-469-2119
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2007
Last Update Date : 02/25/2026

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Directions to “ CHANUWAT M. SUNTALUS PA-C” Practice Location

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