Provider Demographics
NPI:1801483821
Name:SUAREZ MENDOZA, GEORGINA MARIA
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:MARIA
Last Name:SUAREZ MENDOZA
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 1:6845 W 3RD CT APT 301F
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5331
Mailing Address - Country:US
Mailing Address - Phone:786-531-7160
Mailing Address - Fax:
Practice Address - Street 1:6845 W 3RD CT APT 301F
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-5331
Practice Address - Country:US
Practice Address - Phone:786-531-7160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010403207QG0300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine