Provider Demographics
NPI:1508390329
Name:MANZANO SUAREZ, JIANEYA (SA-C)
Entity Type:Individual
Prefix:
First Name:JIANEYA
Middle Name:
Last Name:MANZANO SUAREZ
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6305 W 22ND CT APT 204
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-3994
Mailing Address - Country:US
Mailing Address - Phone:786-560-3378
Mailing Address - Fax:
Practice Address - Street 1:6305 W 22ND CT APT 204
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-3994
Practice Address - Country:US
Practice Address - Phone:786-560-3378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17-228246ZC0007X
FLCBHCMS101021171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant