Provider Demographics
NPI:1407387194
Name:SUAREZ, LUCIA DORA
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:DORA
Last Name:SUAREZ
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 1:1095 W 77TH ST
Mailing Address - Street 2:APT 312
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-3952
Mailing Address - Country:US
Mailing Address - Phone:786-797-5713
Mailing Address - Fax:305-901-1797
Practice Address - Street 1:1095 W 77TH ST
Practice Address - Street 2:APT 312
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-3952
Practice Address - Country:US
Practice Address - Phone:786-797-5713
Practice Address - Fax:305-901-1797
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician