MEDICARE: EMMA LEONA SUFFLE

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	183700000X	Pharmacy Technician	84826	CA

General Provider Information

NPI Number	:	1568163384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA LEONA SUFFLE

Provider Business Mailing Address
First Line	:	310 S 3RD ST
Second Line	:
City	:	BLYTHE
State	:	CA
Zip	:	92225-2834
Country	:	US
Telephone Number	:	760-698-3433
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 E HOBSONWAY
Second Line	:
City	:	BLYTHE
State	:	CA
Zip	:	92225-1739
Country	:	US
Telephone Number	:	760-698-3433
Fax Number	:

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

Provider Enumeration Date	:	03/17/2023
Last Update Date	:	03/17/2023

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Directions to “ EMMA LEONA SUFFLE ” Practice Location

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