Provider Demographics
NPI:1114923968
Name:SUZUKI, STEPHEN P (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:SUZUKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4354 LATHAM ST STE 100
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-1777
Mailing Address - Country:US
Mailing Address - Phone:951-683-0650
Mailing Address - Fax:951-774-4610
Practice Address - Street 1:4354 LATHAM ST STE 100
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-1777
Practice Address - Country:US
Practice Address - Phone:951-683-0650
Practice Address - Fax:951-774-4610
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG59716207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA200009735OtherRAILROAD MEDICARE
CAA53518Medicare UPIN
CA00G97160Medicare PIN