| La Suarez A Professional Corporation | |
|
125 S 5th St Ste B Brawley CA 92227-2408 | |
| (760) 344-8100 | |
| (760) 545-0243 |
| Full Name | La Suarez A Professional Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 125 S 5th St Ste B, Brawley, California |
| Authorized Official Name and Position | Lorenzo Suarez (PRESIDENT) |
| Authorized Official Contact | 7604984407 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| La Suarez A Professional Corporation 125 S 5th St Ste B Brawley CA 92227-2408 Ph: (760) 344-8100 | La Suarez A Professional Corporation 125 S 5th St Ste B Brawley CA 92227-2408 Ph: (760) 344-8100 |
| NPI Number | 1841074267 |
|---|---|
| Provider Enumeration Date | 08/24/2023 |
| Last Update Date | 08/24/2023 |
| Medicare PECOS PAC ID | 4082063201 |
|---|---|
| Medicare Enrollment ID | O20231213003896 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841074267 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Lorenzo H Suarez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619935137 PECOS PAC ID: 4486647039 Enrollment ID: I20120215000249 |
| Provider Name | Richard M Fitzsimmons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275550709 PECOS PAC ID: 0749448546 Enrollment ID: I20120224000679 |
| Provider Name | Oscar Chavez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063880524 PECOS PAC ID: 9638467897 Enrollment ID: I20161004002286 |
| Provider Name | John Allen Friedline |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447311261 PECOS PAC ID: 8628011442 Enrollment ID: I20170912000730 |
| Provider Name | Daniel Samano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003263963 PECOS PAC ID: 6608133111 Enrollment ID: I20180105001399 |
| Provider Name | Jessica J Iten |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538752431 PECOS PAC ID: 0547646671 Enrollment ID: I20220927003167 |
| Provider Name | Mario A Aguirre |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366813065 PECOS PAC ID: 2163873118 Enrollment ID: I20240104000628 |
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