Provider Demographics
NPI:1184004210
Name:SUAREZ, LUIS ENIQUE (MFT)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ENIQUE
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 WRIGHT AVE APT 59
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-4457
Mailing Address - Country:US
Mailing Address - Phone:650-280-3187
Mailing Address - Fax:
Practice Address - Street 1:611 VETERANS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1462
Practice Address - Country:US
Practice Address - Phone:650-280-3187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47274106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist