Provider Demographics
NPI:1962949602
Name:SUAREZ, CYNTHIA (BA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12706 17TH ST
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3613
Mailing Address - Country:US
Mailing Address - Phone:909-815-7860
Mailing Address - Fax:
Practice Address - Street 1:12706 17TH ST
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3613
Practice Address - Country:US
Practice Address - Phone:909-815-7860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician