Healthcare Provider Details

I. General information

NPI: 1922687375
Provider Name (Legal Business Name): ROSAURA SUAZO AGUERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE
BOSTON MA
02215-5400
US

IV. Provider business mailing address

1085 BOYLSTON ST APT 2015
BOSTON MA
02215-3665
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-3524
  • Fax:
Mailing address:
  • Phone: 617-372-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number286539
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number286539
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: