Provider Demographics
NPI:1336350396
Name:SUWYN, ERIC CLAY
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:CLAY
Last Name:SUWYN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15530 W MAUNA LOA LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-6278
Mailing Address - Country:US
Mailing Address - Phone:805-302-9955
Mailing Address - Fax:
Practice Address - Street 1:5051 RODEO RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-4790
Practice Address - Country:US
Practice Address - Phone:323-292-2202
Practice Address - Fax:323-292-2552
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians