Healthcare Provider Details

I. General information

NPI: 1972056919
Provider Name (Legal Business Name): SEBASTIAN SUAREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 10/14/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 NW 91 AVE APT 101
CORAL SPRINGS FL
33065
US

IV. Provider business mailing address

300 E OAKLAND PARK BLVD # 341
OAKLAND PARK FL
33334-2148
US

V. Phone/Fax

Practice location:
  • Phone: 786-346-0605
  • Fax:
Mailing address:
  • Phone: 786-346-0605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: