Provider Demographics
NPI:1386193415
Name:SUAREZ, CARLOS JAVIER (BCABA)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:JAVIER
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12125 SW 101ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-2626
Mailing Address - Country:US
Mailing Address - Phone:305-283-6739
Mailing Address - Fax:
Practice Address - Street 1:12125 SW 101ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-2626
Practice Address - Country:US
Practice Address - Phone:305-283-6739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-16-7404106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL681493096Medicaid