Provider Demographics
NPI:1346450665
Name:SUAREZ, ISAIAS C II (SFIDC)
Entity Type:Individual
Prefix:MR
First Name:ISAIAS
Middle Name:C
Last Name:SUAREZ
Suffix:II
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 SAWYERS ARCH
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-1764
Mailing Address - Country:US
Mailing Address - Phone:757-201-4736
Mailing Address - Fax:
Practice Address - Street 1:3325 SENN RD
Practice Address - Street 2:BLDG 55 RM 228
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-5029
Practice Address - Country:US
Practice Address - Phone:757-201-4736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman