Provider Demographics
NPI:1891211280
Name:SUAREZ VERDECIA, HERIBERTO RAMON
Entity Type:Individual
Prefix:
First Name:HERIBERTO
Middle Name:RAMON
Last Name:SUAREZ VERDECIA
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 1:531 NW 93RD TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6339
Mailing Address - Country:US
Mailing Address - Phone:786-658-0101
Mailing Address - Fax:
Practice Address - Street 1:3700 WASHINGTON ST STE 203
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8249
Practice Address - Country:US
Practice Address - Phone:954-983-9191
Practice Address - Fax:954-983-1152
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11028409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily