Provider Demographics
NPI:1518672948
Name:SUTO, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SUTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W CREST ST STE 210
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-1739
Mailing Address - Country:US
Mailing Address - Phone:760-747-3424
Mailing Address - Fax:760-747-3435
Practice Address - Street 1:221 W CREST ST STE 210
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1739
Practice Address - Country:US
Practice Address - Phone:760-747-3424
Practice Address - Fax:760-747-3435
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist