MEDICARE: DIANA SUAZO

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	172V00000X	Community Health Worker		CA
2	175T00000X	Peer Specialist	MPSS-QVZRDZ	CA
3	101YA0400X	Addiction (Substance Use Disorder) Counselor		CA

General Provider Information

NPI Number	:	1548784150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA SUAZO

Provider Business Mailing Address
First Line	:	679 S NEW HAMPSHIRE AVE STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1355
Country	:	US
Telephone Number	:	213-639-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	679 S NEW HAMPSHIRE AVE STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1355
Country	:	US
Telephone Number	:	213-639-2500
Fax Number	:

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

Provider Enumeration Date	:	07/26/2017
Last Update Date	:	04/16/2026

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Directions to “ DIANA SUAZO ” Practice Location

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