Provider Demographics
NPI:1841275104
Name:HADDOCK-SUAREZ, LILLIAN (MD)
Entity type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:
Last Name:HADDOCK-SUAREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:402 CALLE MINERVA
Mailing Address - Street 2:URB. DOS PINOS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-2312
Mailing Address - Country:US
Mailing Address - Phone:787-763-7109
Mailing Address - Fax:787-282-7665
Practice Address - Street 1:CENTRO DE DIABETES PARA PUERTO RICO
Practice Address - Street 2:PISO 1 EDIF. FARMACIA RCM, CENTRO MEDICO DE PR
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00935
Practice Address - Country:US
Practice Address - Phone:787-773-8283
Practice Address - Fax:787-773-8303
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR1457207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE22677Medicare UPIN
PR2-2299Medicare PIN