Provider Demographics
NPI:1982161204
Name:SUAZA, EDWIN FRANCISCO (PA-C)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:FRANCISCO
Last Name:SUAZA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E 11TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4365
Mailing Address - Country:US
Mailing Address - Phone:712-264-3500
Mailing Address - Fax:
Practice Address - Street 1:116 E 11TH ST STE 101
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4365
Practice Address - Country:US
Practice Address - Phone:712-264-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant