Provider Demographics
NPI:1619935137
Name:SUAREZ, LORENZO H (MD)
Entity Type:Individual
Prefix:MR
First Name:LORENZO
Middle Name:H
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 WEST ATEN ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251
Mailing Address - Country:US
Mailing Address - Phone:760-355-7730
Mailing Address - Fax:760-355-7731
Practice Address - Street 1:125 SOUTH 5TH STREET
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227
Practice Address - Country:US
Practice Address - Phone:760-344-8100
Practice Address - Fax:760-344-2628
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G528480Medicaid
CAZZZ47486ZOtherBLUE SHIELD OF CALIFORNIA
CAW13536COtherMEDICARE GROUP #
CAZZZ08265ZOtherBLUE SHIELD OF CALIFORNIA
CAGR0066315OtherMEDI-CAL GROUP #
CAWG52848DOtherMEDICARE PTAN
CACC6635Medicare PIN
CAW13536COtherMEDICARE GROUP #
CAZZZ08265ZOtherBLUE SHIELD OF CALIFORNIA
CAWG79700AMedicare PIN