Provider Demographics
NPI:1801063300
Name:GEORGE UMAGUING SUYAT, MD, INC.
Entity type:Organization
Organization Name:GEORGE UMAGUING SUYAT, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:UMAGUING
Authorized Official - Last Name:SUYAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:213-413-8836
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52106261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A521060Medicaid
CA1023047669OtherINDIVIDUAL NP1
CA00A521060Medicaid