Provider Demographics
NPI: | 1528385267 |
---|---|
Name: | SUAREZ-KELLY, LORENA PATRICIA (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | LORENA |
Middle Name: | PATRICIA |
Last Name: | SUAREZ-KELLY |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 3016 W CHARLESTON BLVD STE 100 |
Mailing Address - Street 2: | |
Mailing Address - City: | LAS VEGAS |
Mailing Address - State: | NV |
Mailing Address - Zip Code: | 89102-1973 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 402-212-6119 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1707 W CHARLESTON BLVD STE 160 |
Practice Address - Street 2: | |
Practice Address - City: | LAS VEGAS |
Practice Address - State: | NV |
Practice Address - Zip Code: | 89102-2354 |
Practice Address - Country: | US |
Practice Address - Phone: | 702-671-5150 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2010-04-20 |
Last Update Date: | 2024-02-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WI | 71700-20 | 208600000X |
IN | 01088963A | 208600000X |
390200000X | ||
NV | 23945 | 2086X0206X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2086X0206X | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |