Provider Demographics
NPI:1922561950
Name:GILBERTO SUAREZ JR.
Entity Type:Organization
Organization Name:GILBERTO SUAREZ JR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CUCKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-877-9977
Mailing Address - Street 1:7312 W CHEYENNE AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7425
Mailing Address - Country:US
Mailing Address - Phone:702-877-9977
Mailing Address - Fax:702-899-5501
Practice Address - Street 1:7312 W CHEYENNE AVE STE 4
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7425
Practice Address - Country:US
Practice Address - Phone:702-877-9977
Practice Address - Fax:702-899-5501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GILBERTO SUAREZ JR.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-08
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies