Provider Demographics
NPI:1558924233
Name:SUERO, JUAN
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:SUERO
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 1:11990 SW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1602
Mailing Address - Country:US
Mailing Address - Phone:786-448-7868
Mailing Address - Fax:
Practice Address - Street 1:11990 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1602
Practice Address - Country:US
Practice Address - Phone:786-424-6884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
PR000865-P.A.363A00000X
FLRN9615399163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant