Provider Demographics
NPI:1205681541
Name:SUAREZ INFANTE, JOSE GREGORIO SR
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:GREGORIO
Last Name:SUAREZ INFANTE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:MRS
Other - First Name:JOSE
Other - Middle Name:GREGORIO
Other - Last Name:SUAREZ
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1515 E TROPICANA AVE STE 345
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6542
Mailing Address - Country:US
Mailing Address - Phone:702-444-5757
Mailing Address - Fax:
Practice Address - Street 1:1515 E TROPICANA AVE STE 345
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6542
Practice Address - Country:US
Practice Address - Phone:702-444-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant