Provider Demographics
NPI:1518496223
Name:SUAREZ FERNANDEZ, YUDITH
Entity Type:Individual
Prefix:
First Name:YUDITH
Middle Name:
Last Name:SUAREZ FERNANDEZ
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 1:321 TO TO LO CHEE DR
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5239
Mailing Address - Country:US
Mailing Address - Phone:305-951-4957
Mailing Address - Fax:305-901-1797
Practice Address - Street 1:16524 SW 104TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-3025
Practice Address - Country:US
Practice Address - Phone:786-366-8413
Practice Address - Fax:305-901-1797
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician