Healthcare Provider Details

I. General information

NPI: 1437670171
Provider Name (Legal Business Name): EDUARDO SUAREZ MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1469 NW 36TH ST
MIAMI FL
33142-5557
US

IV. Provider business mailing address

1469 NW 36TH ST
MIAMI FL
33142-5557
US

V. Phone/Fax

Practice location:
  • Phone: 786-433-8632
  • Fax: 305-635-6378
Mailing address:
  • Phone: 786-433-8632
  • Fax: 305-635-6378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCCMS100069-AC
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: