Healthcare Provider Details

I. General information

NPI: 1093547671
Provider Name (Legal Business Name): SUCHITEL CUADRAS-DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUCHITEL CUADRAS-DIAZ RBT

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 SE GOLDTREE DR
PORT ST LUCIE FL
34952-7584
US

IV. Provider business mailing address

268 SE VERADA AVE
PORT ST LUCIE FL
34983-2139
US

V. Phone/Fax

Practice location:
  • Phone: 772-212-7539
  • Fax: 772-673-8392
Mailing address:
  • Phone: 407-921-1521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-356496
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: