MEDICARE: KATHERINE SUAZO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst	6502	TX

General Provider Information

NPI Number	:	1386115731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE SUAZO

Provider Business Mailing Address
First Line	:	749 37TH AVE
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-5124
Country	:	US
Telephone Number	:	844-322-7483
Fax Number	:	888-334-7021

Provider Business Practice Location Address
First Line	:	5522 LONE STAR PKWY STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-6719
Country	:	US
Telephone Number	:	855-782-7822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2018
Last Update Date	:	04/10/2024

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Directions to “ KATHERINE SUAZO ” Practice Location

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