Basic Information
| Provider Information | |||||||||
| NPI: | 1720435316 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUAREZ | ||||||||
| FirstName: | LAURA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14335 SW 120TH ST | ||||||||
| Address2: | 201 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331867294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059678074 | ||||||||
| FaxNumber: | 3059678302 | ||||||||
| Practice Location | |||||||||
| Address1: | 8785 SW 165TH AVE STE 103 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331935827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862066500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2016 | ||||||||
| LastUpdateDate: | 03/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171W00000X | N | Other Service Providers | Contractor | 106S00000X | Y |
No ID Information.