Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036109014 | IL |
NPI | 1003095258 |
---|---|
Provider Name | Dr. Leah L Suarez-Abraham |
First Address | Oak Park, IL 60302-2606 |
Second Address | Watsonville, CA 95076-4809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2007 |
Last Update Date | 20/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H88808 | (02) | IL |