Provider Demographics
NPI:1548423619
Name:SUAREZ, LAURA VERONICA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:VERONICA
Last Name:SUAREZ
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 1:399 DRAKE AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7504
Mailing Address - Country:US
Mailing Address - Phone:831-643-9069
Mailing Address - Fax:
Practice Address - Street 1:320 HAWTHORNE ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-1808
Practice Address - Country:US
Practice Address - Phone:831-643-9069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA44CFOtherMEDI-CAL PRV NBR
CA27BW8OtherMEDI-CAL PRV NBR
CAB6501950OtherDRIVER'S LICENSE