Provider Demographics
NPI:1134699838
Name:SUAREZ RIVERA, JAVIER JESUS
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:JESUS
Last Name:SUAREZ RIVERA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11415 CASWELL SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-8325
Mailing Address - Country:US
Mailing Address - Phone:502-298-9121
Mailing Address - Fax:
Practice Address - Street 1:11415 CASWELL SPRINGS WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-8325
Practice Address - Country:US
Practice Address - Phone:502-298-9121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11034541363LF0000X
KY4018518363LF0000X, 363L00000X
246ZC0007X
CA95034053363LF0000X
IL209-03153401363LF0000X
IL20903153401363LF0000X
IL209.031534363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner