Provider Demographics
NPI:1255776894
Name:SUAREZ, MARTHA JEAN (PMHNP)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:JEAN
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MS
Other - First Name:MARTHA
Other - Middle Name:JEAN
Other - Last Name:VOLODKEVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:510 1ST AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-6777
Mailing Address - Country:US
Mailing Address - Phone:619-962-8383
Mailing Address - Fax:
Practice Address - Street 1:200 MERCY CIRCLE
Practice Address - Street 2:
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:760-725-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340032163WP0808X
CA22004363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health