Provider Demographics
NPI:1437651056
Name:SUAREZ GONZALEZ, LISBET (BA)
Entity type:Individual
Prefix:MRS
First Name:LISBET
Middle Name:
Last Name:SUAREZ GONZALEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8540 SW 133 AVE RD APT 318
Mailing Address - Street 2:8540 SW 133 AVE RD APR 318
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4518
Mailing Address - Country:US
Mailing Address - Phone:305-766-2721
Mailing Address - Fax:
Practice Address - Street 1:8540 SW 133RD AVENUE RD APT 318
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4518
Practice Address - Country:US
Practice Address - Phone:305-766-2721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLS625520758860106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023202200Medicaid