Healthcare Provider Details

I. General information

NPI: 1427597335
Provider Name (Legal Business Name): CARLOS JULIO SUAREZ MEDINA RN, BSN, MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 05/24/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MAGA FINAL PABELLON G TERRENO PSIQUIATRIA ESTATAL
SAN JUAN PR
00921
US

IV. Provider business mailing address

444 CONDOMINIO DE DIEGO APT 501
SAN JUAN PR
00923
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number80463
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number80463
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number80463
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number80463
License Number StatePR
# 5
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number80463
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: