Healthcare Provider Details

I. General information

NPI: 1821235581
Provider Name (Legal Business Name): SUZETTE SOPHIA PREBLE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 11/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2677 FOREST HILL BLVD SUITE 102-103
WEST PALM BEACH FL
33406-5949
US

IV. Provider business mailing address

13747 50TH PL N
ROYAL PALM BEACH FL
33411-8155
US

V. Phone/Fax

Practice location:
  • Phone: 561-433-0123
  • Fax:
Mailing address:
  • Phone: 561-860-0348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License NumberMA 50419
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: