Healthcare Provider Details

I. General information

NPI: 1790383735
Provider Name (Legal Business Name): DENICE SUAREZ MACHIN RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 FOREST HILL BLVD STE 3
LAKE CLARKE SHORES FL
33406-6031
US

IV. Provider business mailing address

2136 BONNIE DR
WEST PALM BEACH FL
33415-7206
US

V. Phone/Fax

Practice location:
  • Phone: 561-444-2814
  • Fax: 561-444-2458
Mailing address:
  • Phone: 561-229-8508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number19-86712
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: