Provider Demographics
NPI:1710414248
Name:SORIA CABEZAS, SUZEL
Entity Type:Individual
Prefix:
First Name:SUZEL
Middle Name:
Last Name:SORIA CABEZAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 SW 31ST PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-1148
Mailing Address - Country:US
Mailing Address - Phone:305-877-5076
Mailing Address - Fax:
Practice Address - Street 1:331 SW 31ST PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-1148
Practice Address - Country:US
Practice Address - Phone:305-877-5076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FLRBT-18-73471106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician