Provider Demographics
NPI:1659555753
Name:SUAREZ DE LEON, SMIRNA (NUTRITIONIST)
Entity Type:Individual
Prefix:
First Name:SMIRNA
Middle Name:
Last Name:SUAREZ DE LEON
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URBAN HEALTH PLAN INC
Mailing Address - Street 2:1065 SOUTHERN BOULEVARD
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459
Mailing Address - Country:US
Mailing Address - Phone:718-589-2440
Mailing Address - Fax:718-589-7558
Practice Address - Street 1:URBAN HEALTH PLAN INC
Practice Address - Street 2:1065 SOUTHERN BOULEVARD
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459
Practice Address - Country:US
Practice Address - Phone:718-589-2440
Practice Address - Fax:718-589-7558
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004805133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education