Provider Demographics
NPI:1235387994
Name:GARCIA-SUAZO, LYDIANA
Entity Type:Individual
Prefix:MRS
First Name:LYDIANA
Middle Name:
Last Name:GARCIA-SUAZO
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 1:30825 PENNY SURF LOOP
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-2306
Mailing Address - Country:US
Mailing Address - Phone:310-592-3333
Mailing Address - Fax:
Practice Address - Street 1:3031 N SAN FERNANDO BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-4704
Practice Address - Country:US
Practice Address - Phone:310-592-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11720103TC0700X
PR3838103TC1900X
CAPSY24888103TC1900X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling