Healthcare Provider Details

I. General information

NPI: 1790467322
Provider Name (Legal Business Name): EMMANUEL SUAREZ MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1914 256TH ST
O BRIEN FL
32071-4609
US

IV. Provider business mailing address

10540 SW 154TH CT APT 7
MIAMI FL
33196-3597
US

V. Phone/Fax

Practice location:
  • Phone: 786-444-6341
  • Fax:
Mailing address:
  • Phone: 786-444-6341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number23-285085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: