Provider Demographics
NPI:1255729018
Name:JEAN-LOUIS, SUZIE (MD)
Entity type:Individual
Prefix:
First Name:SUZIE
Middle Name:
Last Name:JEAN-LOUIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:L5 CALLE 1
Mailing Address - Street 2:URB REXMANOR
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784-6018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:L5 CALLE 1
Practice Address - Street 2:URB REXMANOR
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-6018
Practice Address - Country:US
Practice Address - Phone:305-761-6129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18969208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice