Healthcare Provider Details

I. General information

NPI: 1992488084
Provider Name (Legal Business Name): SOFIA SANTIESTEBAN SUAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2348 W 66TH PL
HIALEAH FL
33016-3973
US

IV. Provider business mailing address

11060 SW 88TH ST
MIAMI FL
33176-1272
US

V. Phone/Fax

Practice location:
  • Phone: 305-833-3242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-262831038
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: