Basic Information
| Provider Information | |||||||||
| NPI: | 1760853865 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUAREZ | ||||||||
| FirstName: | REYNALDO | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | CNMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 398 E ALTAMONTE DR | ||||||||
| Address2: | |||||||||
| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327014402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073319355 | ||||||||
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| Practice Location | |||||||||
| Address1: | 398 E ALTAMONTE DR | ||||||||
| Address2: | |||||||||
| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327014402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073319355 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2015 | ||||||||
| LastUpdateDate: | 10/14/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2471N0900X | CRT81853 | FL | Y | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Nuclear Medicine Technology |
No ID Information.