Provider Demographics
NPI:1659738078
Name:SUAREZ, MICHAEL JOSEPH (COTA/L)
Entity Type:Individual
Prefix:
First Name:MICHAEL JOSEPH
Middle Name:
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22031 MAIN ST
Mailing Address - Street 2:UNIT 17
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2971
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22031 MAIN ST
Practice Address - Street 2:UNIT 17
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2971
Practice Address - Country:US
Practice Address - Phone:310-721-6116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA2942314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility