Provider Demographics
NPI:1114705068
Name:SUAREZ CARDENAS, IVIS LEYDIS
Entity Type:Individual
Prefix:
First Name:IVIS
Middle Name:LEYDIS
Last Name:SUAREZ CARDENAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7006 FERN CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7906
Mailing Address - Country:US
Mailing Address - Phone:813-648-8390
Mailing Address - Fax:
Practice Address - Street 1:7006 FERN CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-7906
Practice Address - Country:US
Practice Address - Phone:813-648-8390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician