Healthcare Provider Details

I. General information

NPI: 1265628176
Provider Name (Legal Business Name): ROSA M CUELLO-SUAREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 FOREST HILL BLVD STE 100
WEST PALM BEACH FL
33406-6063
US

IV. Provider business mailing address

1840 FOREST HILL BLVD STE 100
WEST PALM BEACH FL
33406-6063
US

V. Phone/Fax

Practice location:
  • Phone: 561-964-5161
  • Fax: 561-232-3086
Mailing address:
  • Phone: 561-964-5161
  • Fax: 561-232-3086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0071562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: