Healthcare Provider Details

I. General information

NPI: 1316156755
Provider Name (Legal Business Name): CARLOS R SUAREZ P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 NW 25TH ST SUITE 4
DORAL FL
33122-1625
US

IV. Provider business mailing address

5080 SPECTRUM DR SUITE 1200 WEST
ADDISON TX
75001-4648
US

V. Phone/Fax

Practice location:
  • Phone: 305-593-2174
  • Fax:
Mailing address:
  • Phone: 972-364-8000
  • Fax: 214-775-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2960
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: