Provider Demographics
NPI:1639482946
Name:SUERO, AVIVA (BS,PT)
Entity Type:Individual
Prefix:
First Name:AVIVA
Middle Name:
Last Name:SUERO
Suffix:
Gender:F
Credentials:BS,PT
Other - Prefix:
Other - First Name:AVIVA
Other - Middle Name:ERIN
Other - Last Name:POTOCNIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS, PT
Mailing Address - Street 1:3240 ARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2015
Mailing Address - Country:US
Mailing Address - Phone:916-486-5460
Mailing Address - Fax:
Practice Address - Street 1:8241 E STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-8200
Practice Address - Country:US
Practice Address - Phone:415-305-7218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist