Provider Demographics
NPI:1437929809
Name:SUAREZ QUESADA, LIETIS
Entity Type:Individual
Prefix:
First Name:LIETIS
Middle Name:
Last Name:SUAREZ QUESADA
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 1:7500 SW 30TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2748
Mailing Address - Country:US
Mailing Address - Phone:786-665-2673
Mailing Address - Fax:
Practice Address - Street 1:7500 SW 30TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2748
Practice Address - Country:US
Practice Address - Phone:786-665-2673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-318674106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician