Individual provider Active NPI

Laverni Canonigo Suico, FNP-C

  • Family Nurse Practitioner
  • Fontana, CA
National Provider Identifier
1396534335
Registry record updated May 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95030500 Issued in CA
Practice address
4989 Agave Ave
Fontana, CA 92336-5961
Phone
(323) 447-3068
NPI assigned
May 5, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 5, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95030500 CA Primary

Addresses

Primary practice location

4989 Agave Ave
Fontana, CA 92336-5961

Mailing address

4989 Agave Ave
Fontana, CA 92336-5961
Phone (323) 447-3068

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260504006100 CA Practitioner - Nurse Practitioner 1456829985 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Karefirst Nursing California PCGroup PAC ID 2264908326, 10 clinicians

Practice addresses (Care Compare)

1899 N Raymond Ave
Pasadena, CA 91103-1733
Phone (626) 797-2120

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
95030500CAMDFamily Nurse Practitioner

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1746403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746403200000",
    "number": "1396534335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4989 AGAVE AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923365961",
            "telephone_number": "323-447-3068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4989 AGAVE AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923365961",
            "telephone_number": "323-447-3068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUICO",
        "first_name": "LAVERNI",
        "middle_name": "CANONIGO",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-05-05",
        "last_updated": "2025-05-05",
        "certification_date": "2025-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95030500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fontana, CA

Sources for this page

Verify at the official NPI Registry.