MEDICARE: CHRISTIAN SUAREZ FUENTES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	ME126938	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467732743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN SUAREZ FUENTES

Provider Business Mailing Address
First Line	:	7900 SW 57TH AVE
Second Line	:	SUITE 21
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-5522
Country	:	US
Telephone Number	:	305-662-3984
Fax Number	:

Provider Business Practice Location Address
First Line	:	7900 SW 57TH AVE
Second Line	:	SUITE 21
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-5547
Country	:	US
Telephone Number	:	305-662-3984
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2011
Last Update Date	:	06/29/2016

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