Provider Demographics
NPI:1265864557
Name:SUAREZ, SHAUN P
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:P
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 N SAN JACINTO ST STE P
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3154
Mailing Address - Country:US
Mailing Address - Phone:951-929-4000
Mailing Address - Fax:951-929-4100
Practice Address - Street 1:540 N SAN JACINTO ST STE P
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3154
Practice Address - Country:US
Practice Address - Phone:951-929-4000
Practice Address - Fax:951-929-4100
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA833375163W00000X
CA95017083363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse