1508913526 NPI number — MS. MILDRED SUAREZ M.S., C.C.C.

Table of content: MS. MILDRED SUAREZ M.S., C.C.C. (NPI 1508913526)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508913526 NPI number — MS. MILDRED SUAREZ M.S., C.C.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUAREZ
Provider First Name:
MILDRED
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., C.C.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SUAREZ
Provider Other First Name:
MILLIE
Provider Other Middle Name:
MARTINEZ
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., C.C.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1508913526
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8510 SW 8TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33144-4053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-266-5353
Provider Business Mailing Address Fax Number:
305-266-6550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8510 SW 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33144-4053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-266-5353
Provider Business Practice Location Address Fax Number:
305-266-6550
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SA 1502 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QH0700X , with the licence number: SA1502 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 237488 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 65-0303523 . This is a "SOUTH CARE PPO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 65-0303523 . This is a "VISTA HEALTH PLAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 880762101 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4602011 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: S0638 . This is a "BCBS BILLING NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 65-0303523 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 38616 . This is a "NHP PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 880762100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102170 . This is a "AV-MED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2692772-001 . This is a "CIGNA HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 880762100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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