Provider Demographics
NPI:1508812645
Name:SUAREZ, BORIS M (PA-C)
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:M
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 E EL MONTE WAY
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-1812
Mailing Address - Country:US
Mailing Address - Phone:559-591-3342
Mailing Address - Fax:
Practice Address - Street 1:1451 E EL MONTE WAY
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-1812
Practice Address - Country:US
Practice Address - Phone:559-591-3342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16450363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant