Provider Demographics
NPI:1710163969
Name:SUTA CENTER INC
Entity Type:Organization
Organization Name:SUTA CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESTIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PFANNENSTIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-556-7599
Mailing Address - Street 1:2106 TYLER ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6717
Mailing Address - Country:US
Mailing Address - Phone:786-566-7599
Mailing Address - Fax:
Practice Address - Street 1:2106 TYLER ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6717
Practice Address - Country:US
Practice Address - Phone:786-566-7599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 8891251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1134305303OtherNPI INDIVIDUAL