Provider Demographics
NPI:1295030062
Name:SUAREZ, JOSE RAUL JR (MA)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:RAUL
Last Name:SUAREZ
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3101 E 5TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-8510
Mailing Address - Country:US
Mailing Address - Phone:213-385-5100
Mailing Address - Fax:213-252-5870
Practice Address - Street 1:19700 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1100
Practice Address - Country:US
Practice Address - Phone:213-385-5100
Practice Address - Fax:213-252-5870
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner