Provider Demographics
NPI:1649811472
Name:SUAREZ GONZALEZ, ANA LAURA
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:LAURA
Last Name:SUAREZ GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 MAPLE AVE APT 213A
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-6911
Mailing Address - Country:US
Mailing Address - Phone:787-362-9933
Mailing Address - Fax:
Practice Address - Street 1:225 S FULTON ST STE D
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3344
Practice Address - Country:US
Practice Address - Phone:607-437-0141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024057225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist