Provider Demographics
NPI:1184447252
Name:SUAREZ, IVAN
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:SUAREZ
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 1:13115 W OKEECHOBEE RD STE 111-112
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6041
Mailing Address - Country:US
Mailing Address - Phone:786-355-4722
Mailing Address - Fax:786-953-8481
Practice Address - Street 1:13115 W OKEECHOBEE RD STE 111-112
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-6041
Practice Address - Country:US
Practice Address - Phone:786-355-4722
Practice Address - Fax:786-953-8481
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company