Healthcare Provider Details

I. General information

NPI: 1790328086
Provider Name (Legal Business Name): CAROLINA J CHIRINOS SUAREZ SA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2019
Last Update Date: 10/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 PELHAM RD APT 46
GREENVILLE SC
29615-2518
US

IV. Provider business mailing address

230 PELHAM RD APT 46
GREENVILLE SC
29615-2518
US

V. Phone/Fax

Practice location:
  • Phone: 864-520-9923
  • Fax:
Mailing address:
  • Phone: 864-520-9923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number19-424
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: