Provider Demographics
NPI:1427277144
Name:SUAREZ, EDGARDO CARLOS (DC)
Entity type:Individual
Prefix:DR
First Name:EDGARDO
Middle Name:CARLOS
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36074 MUSTANG SPIRIT LN
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7603
Mailing Address - Country:US
Mailing Address - Phone:951-264-3668
Mailing Address - Fax:951-637-2393
Practice Address - Street 1:3838 JACKSON ST STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3917
Practice Address - Country:US
Practice Address - Phone:951-637-7546
Practice Address - Fax:951-637-2393
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor