Provider Demographics
NPI:1275683195
Name:SUAREZ, CARMEN I (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:I
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3138
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-3138
Mailing Address - Country:US
Mailing Address - Phone:787-786-6792
Mailing Address - Fax:787-798-5253
Practice Address - Street 1:SUITE 202 PASEO SAN PABLO # 100
Practice Address - Street 2:DR ARTURO CADILLA BUILDING
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3138
Practice Address - Country:US
Practice Address - Phone:787-786-6792
Practice Address - Fax:787-798-5253
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11663208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11663OtherLICENCE NUMBER