Provider Demographics
NPI:1487182093
Name:SUAREZ BERUMEN, KATIA (DO)
Entity Type:Individual
Prefix:DR
First Name:KATIA
Middle Name:
Last Name:SUAREZ BERUMEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 E KATELLA AVE UNIT 212
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-8692
Mailing Address - Country:US
Mailing Address - Phone:619-654-0350
Mailing Address - Fax:
Practice Address - Street 1:301 W WASHINGTON ST # 116
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1930
Practice Address - Country:US
Practice Address - Phone:858-754-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A16702207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty