Provider Demographics
NPI:1295972503
Name:GUILLERMO SUAREZ P.L.
Entity type:Organization
Organization Name:GUILLERMO SUAREZ P.L.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEBRALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:TORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-727-7540
Mailing Address - Street 1:4132 20TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-5001
Mailing Address - Country:US
Mailing Address - Phone:941-727-7540
Mailing Address - Fax:941-752-1717
Practice Address - Street 1:4132 20TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-5001
Practice Address - Country:US
Practice Address - Phone:941-727-7540
Practice Address - Fax:941-752-1717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME18567261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care