Provider Demographics
NPI:1023047669
Name:SUYAT, GEORGE UMAGUING (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:UMAGUING
Last Name:SUYAT
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
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Mailing Address - Street 1:2105 BEVERLY BLVD
Mailing Address - Street 2:SUITE 131
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2216
Mailing Address - Country:US
Mailing Address - Phone:213-413-8836
Mailing Address - Fax:213-413-2616
Practice Address - Street 1:2105 BEVERLY BLVD
Practice Address - Street 2:SUITE 131
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2216
Practice Address - Country:US
Practice Address - Phone:213-413-8836
Practice Address - Fax:213-413-2616
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA52106207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52106OtherSTATE LICENSE
CA00A521060Medicaid
CAG18833Medicare UPIN
CA00A521060Medicaid