Provider Demographics
NPI:1851684914
Name:RAMIREZ SUERO, LISSETTE (MD)
Entity Type:Individual
Prefix:
First Name:LISSETTE
Middle Name:
Last Name:RAMIREZ SUERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISSETTE
Other - Middle Name:
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:560 GAGE BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8650
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-942-2268
Practice Address - Street 1:560 GAGE BLVD STE 203
Practice Address - Street 2:KADLEC CLINIC SENIOR HEALTH
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-8650
Practice Address - Country:US
Practice Address - Phone:509-942-3627
Practice Address - Fax:509-942-2268
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY61003794207RG0300X
WAMD60346972207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1851684914Medicaid