Provider Demographics
NPI:1164984787
Name:MORALES-SUARES, CAESAR
Entity Type:Individual
Prefix:
First Name:CAESAR
Middle Name:
Last Name:MORALES-SUARES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12240 NW BARNES RD APT 28
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5950
Mailing Address - Country:US
Mailing Address - Phone:971-600-7579
Mailing Address - Fax:
Practice Address - Street 1:12240 NW BARNES RD APT 28
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5950
Practice Address - Country:US
Practice Address - Phone:971-600-7579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2563342106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician