Provider Demographics
NPI:1568163384
Name:SUFFLE, EMMA LEONA
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:LEONA
Last Name:SUFFLE
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 1:310 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-2834
Mailing Address - Country:US
Mailing Address - Phone:760-698-3433
Mailing Address - Fax:
Practice Address - Street 1:616 E HOBSONWAY
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1739
Practice Address - Country:US
Practice Address - Phone:760-698-3433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84826183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician