Provider Demographics
NPI:1558974527
Name:SUAREZ-LARREA, DAVID RAMIRO
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RAMIRO
Last Name:SUAREZ-LARREA
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 1:1855 NW 15TH AVE APT 403
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2466
Mailing Address - Country:US
Mailing Address - Phone:305-915-2231
Mailing Address - Fax:
Practice Address - Street 1:1855 NW 15TH AVE APT 403
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2466
Practice Address - Country:US
Practice Address - Phone:305-915-2231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT20120823106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician