Provider Demographics
NPI:1992221212
Name:SUAREZ MORALES, IDA ELENA
Entity Type:Individual
Prefix:
First Name:IDA
Middle Name:ELENA
Last Name:SUAREZ MORALES
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 1:949 PNNSYLVN AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-5422
Mailing Address - Country:US
Mailing Address - Phone:305-684-4822
Mailing Address - Fax:
Practice Address - Street 1:2500 NW 79TH AVE STE 116
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1075
Practice Address - Country:US
Practice Address - Phone:305-591-7898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst