Healthcare Provider Details

I. General information

NPI: 1922730126
Provider Name (Legal Business Name): STACY JOANA SUAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 MAPLE AVE STE 100
DALLAS TX
75235-6596
US

IV. Provider business mailing address

5701 MAPLE AVE STE 100
DALLAS TX
75235-6596
US

V. Phone/Fax

Practice location:
  • Phone: 214-351-6600
  • Fax: 214-351-5046
Mailing address:
  • Phone: 214-351-6600
  • Fax: 214-351-5046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number216312
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: