Provider Demographics
NPI:1477226355
Name:SUAREZ, CARLOS ESTEBAN
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ESTEBAN
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 NE UPPER DR
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-4305
Mailing Address - Country:US
Mailing Address - Phone:509-592-7117
Mailing Address - Fax:
Practice Address - Street 1:4732 S KEYES CT
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-8276
Practice Address - Country:US
Practice Address - Phone:509-592-7117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC56149171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter