Provider Demographics
NPI:1578834735
Name:SUVA, AUSTINE PINTOR (IDC)
Entity type:Individual
Prefix:MR
First Name:AUSTINE
Middle Name:PINTOR
Last Name:SUVA
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 NATIONAL CITY BLVD UNIT 1112
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-3261
Mailing Address - Country:US
Mailing Address - Phone:808-627-5520
Mailing Address - Fax:
Practice Address - Street 1:801 NATIONAL CITY BLVD UNIT 1112
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-3261
Practice Address - Country:US
Practice Address - Phone:808-627-5520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman