Provider Demographics
NPI:1205471273
Name:SUITEDOC SPECIALTY NETWORK
Entity type:Organization
Organization Name:SUITEDOC SPECIALTY NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ALVAMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TABALON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-829-3982
Mailing Address - Street 1:7660 FAY AVE # 351
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-0021
Mailing Address - Country:US
Mailing Address - Phone:844-377-8483
Mailing Address - Fax:
Practice Address - Street 1:655 EUCLID AVE STE 301
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2972
Practice Address - Country:US
Practice Address - Phone:844-377-8483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty