Provider Demographics
NPI:1275590028
Name:SUAREZ, ANGELI D (MD)
Entity Type:Individual
Prefix:
First Name:ANGELI
Middle Name:D
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11122 RANGER DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2649
Mailing Address - Country:US
Mailing Address - Phone:270-836-1737
Mailing Address - Fax:
Practice Address - Street 1:11100 WARNER AVE STE 368
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7514
Practice Address - Country:US
Practice Address - Phone:714-241-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29114208000000X
CAC148727208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000108207OtherBCBS
KY64291149Medicaid
KYF34213Medicare UPIN
KY0641801Medicare ID - Type Unspecified