Basic Information
| Provider Information | |||||||||
| NPI: | 1619935137 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUAREZ | ||||||||
| FirstName: | LORENZO | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 516 WEST ATEN ROAD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | IMPERIAL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603557730 | ||||||||
| FaxNumber: | 7603557731 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 SOUTH 5TH STREET | ||||||||
| Address2: | |||||||||
| City: | BRAWLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603448100 | ||||||||
| FaxNumber: | 7603442628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 10/16/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G52848 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00G528480 | 05 | CA | MEDICAID | ZZZ47486Z | 01 | CA | BLUE SHIELD OF CALIFORNIA | OTHER | W13536C | 01 | CA | MEDICARE GROUP # | OTHER | ZZZ08265Z | 01 | CA | BLUE SHIELD OF CALIFORNIA | OTHER | GR0066315 | 01 | CA | MEDI-CAL GROUP # | OTHER | WG52848D | 01 | CA | MEDICARE PTAN | OTHER |